Diabetes Management

Diabetes and Exercise: When To Monitor Your Blood Sugar

Managing diabetes can be a complicated task. Many factors can influence a person’s blood sugar levels on a day-to-day basis.

What works one day for keeping blood sugars under control may result in higher blood sugars the next day. While this can be frustrating, regular exercise can help.

Not only can exercise help manage blood sugars, but being physically active can help reduce the risk of developing complications from diabetes, such as cardiovascular, or heart disease.

Physical activity is crucial for everyone’s health, not just those with diabetes.

Unfortunately, many people fall short of the recommended exercise recommendations. This may be in part due to busy schedules, sedentary jobs, and long commutes.

Understanding the benefits of exercise can be motivating for those wanting to improve their health. Best of all, exercise can be completely free – no need for a gym membership or fancy equipment.

Most important of all is to find a form of exercise that is enjoyable so that it can be part of a sustainable lifestyle.

The link between diabetes and exercise

Diabetes mellitus, or diabetes, is a disease where the body doesn’t produce enough insulin, or it doesn’t respond to insulin effectively. Insulin is a hormone that helps move glucose (our body’s primary fuel source) from our bloodstream into our cells, where it’s used as energy.

Without enough insulin, blood sugar levels rise too high, which can cause many complications and even be deadly.

Type 1 diabetes is an autoimmune disease that impacts the pancreas, which is the organ that produces insulin. People with type 1 diabetes don’t make any insulin on their own, so they must inject insulin daily.

Type 2 diabetes often occurs due to insulin resistance, which occurs when the body doesn’t use insulin as it should. People with type 2 diabetes can also become insulin deficient, similar to type 1, over time.

During the initial phase of physical activity, blood sugar levels can actually increase as the liver and muscle release stored sugar to be used as fuel. This stored sugar is called glycogen.

When we’re active for longer durations of time, our bodies start to take up more glucose (blood sugar) for fuel. Muscles take up 50 times more glucose during physical activity than when sedentary, without the need for insulin.

This is why it’s so beneficial for people with diabetes. After being active, the body replenishes its glycogen stores by taking sugar from the blood and storing it as glycogen. Because of this, blood sugars can be lower for several hours after exercise has ceased as the body restores its storage of sugar.

Benefits of physical activity for diabetes

Diabetes Prevention

A sedentary lifestyle is one of the risk factors for developing type 2 diabetes. Exercise can help improve insulin resistance, which is a precursor to type 2 diabetes.

When someone is insulin resistant, their pancreas needs to release more and more insulin to keep blood sugar levels in control. Over time, the pancreas can become overworked and start to lose its ability to make enough insulin.

On the other hand, exercise helps the body use less insulin to keep blood sugar levels in check.

Even if a person’s body isn’t producing enough insulin, the muscles can still take up extra blood sugar. This is why being active is an excellent diabetes prevention strategy.

When blood sugar levels are lower and/, or insulin resistance is improved through activity, not as much insulin is required, which can help the pancreas rest.

While other risk factors for developing diabetes can’t be controlled, such as genetics, exercise is one aspect that people can control. Studies have found that a regular physical program, can lower type 2 diabetes risk by up to 58% in high-risk populations.

Type 1 diabetes has different risk factors and isn’t similar to type 2 diabetes in terms of risk factors. The known risk factors for type 1 diabetes include:

  • genetics

  • family history

  • age

  • exposure to certain viruses

  • and other environmental factors, and even geographic location.

Being sedentary isn’t a known risk factor for developing type 1 diabetes as it is with type 2. However, being active is still beneficial for those with type 1 diabetes.

Management of diabetes

Being physically active can help promote healthy blood sugar levels. The American Diabetes Association recommends that people with diabetes take part in at least 150 minutes of physical activity per week, including both aerobic and resistance exercises.

The ADA also recommends not going more than 2 days without exercising due to its health benefits.

Exercise improves insulin action, even if weight loss doesn’t occur. In fact, low-intensity aerobic exercise lasting at least an hour can improve insulin action for at least 24 hours! Exercise can also promote weight loss, which can help improve insulin resistance and lower blood sugar in some people.

Types of exercise

Resistance training: Weight lifting and resistance training help to build muscle strength. Resistance training uses the resistance of body weight to strengthen muscles.

Examples of resistance training include doing push-ups, lunges, and chin-ups. Some older adults prefer using resistance bands as a gentle way of building muscle strength, as it doesn’t require as much power and stability as body weight exercises like lunges.

Weight lifting is especially helpful for people with diabetes. The more lean muscle mass a person has, the better their blood sugars are.

This is because the muscles can take up glucose for fuel regardless of insulin. Weight lifting can even help prevent the progression of prediabetes, turning into diabetes.

Aerobic exercise: Aerobic exercise means “with oxygen.” Heart rate and respiration rate increase in aerobic exercise, and it’s good for the heart, lungs, and circulatory system.

Brisk walking, running, swimming, and bicycling are examples of aerobic exercise. This type of exercise is beneficial for heart health, such as improving cholesterol levels.

Aerobic exercise intensity can be monitored by measuring the heart rate. In high-intensity workouts, such as high-intensity interval training (HIIT), heart rate is brought to a higher percentage (70-90%) of the target heart rate.

To calculate your target heart rate, subtract your age from 220. For example, a 30-year-old’s target heart rate would be 190 beats per minute (BPM), so during HIIT workouts, the heart rate would increase to a maximum of 133 (70%)-171 (90%) BPM. HIIT training is popular because you get the benefit of high-intensity workouts with rest between intervals for built-in recovery.

Flexibility and balance exercises: Stretching the muscles can help with mobility and prevents stiffness.

Yoga and pilates are popular forms of exercise because they’re gentle and easy on the joints. They can help build muscle through the physical challenge of improving balance as well. Yoga helps to improve blood sugar and insulin resistance, as well as to help improve blood lipids like triglycerides and cholesterol.

Improving balance is very helpful in helping prevent falls in older people. One in four Americans 65 years and older experience a fall each year, and falls are the leading cause of fatal and non-fatal injuries in this age group.

Weight-bearing exercises such as walking and climbing stairs also help to improve bone density, which can reduce the risk of fractures from osteoporosis. Overall, staying active is one of the best ways to help reduce falls, and with the added benefit of improved blood sugar in older people with diabetes.

But before you begin exercising…

The benefits of physical activity are multifaceted and especially helpful for people wanting to manage their diabetes. However, there are some special considerations for those with diabetes in order to stay safe.

  • Get cleared for physical activity by your doctor before starting a new exercise program. Certain forms of exercise may be dangerous for people with very high blood pressure. While exercise ultimately can help lower blood pressure, blood pressure is raised during exercise. Some people have increased blood pressure in the eyes; weight lifting can strain on the blood vessels in the eyes and may increase the risk of glaucoma in some cases.

  • If you have heart disease or heart failure, it’s crucial to find a form of exercise that is safe for you. Besides working with your healthcare provider, an exercise physiologist can also help you develop an exercise routine suitable for your health and fitness level.

  • Check your blood sugar before exercise. This is especially important for people taking insulin, or those using an insulin pump. If blood sugar levels are very high and you have type 1 diabetes, check your urine for ketones. If you test positive for ketones, it may be safer to avoid exercise until your blood sugar levels come down.

  • For those wearing an insulin pump, temporarily reducing the basal rate of insulin delivery can help prevent hypoglycemia. Always discuss with your healthcare provider before adjusting insulin pump settings. …and while you’re at it, check blood sugar after exercise, too. Blood sugar tends to drop a few hours after exercising as the body refuels glycogen stores by using up sugar in the blood. If you feel shaky or weak after exercising, definitely check your blood sugar and be ready with a carbohydrate-based meal or snack.

  • Use snacks to your advantage. If blood sugar levels are trending lower, such as below 100 mg/dL, taking a small carbohydrate snack can help prevent hypoglycemia. A small piece of fruit, ½ cup of fruit juice, or a slice of bread are all approximately 15 grams of carbohydrates, which can help provide enough glucose to stabilize blood sugars before exercising.

  • If blood sugar levels are below 70 mg/dL before exercise, that is hypoglycemia, and training should be avoided until blood sugar levels have increased to a safer level. To treat hypoglycemia, take 15 grams of carbohydrates and re-check blood sugar in 15 minutes. Repeat the treatment until hypoglycemia is resolved.

  • Take steps to prevent hypoglycemia. Prolonged periods of exercise can lower blood sugar and cause hypoglycemia once glycogen stores are used up. Glucose tablets are a useful thing to carry while exercising. Glucose tablets provide readily-absorbable glucose and dissolve quickly in the mouth. They are lightweight and portable choice when exercising outdoors.

  • Take care of your feet and choose the right footwear. Diabetes can cause peripheral neuropathy, which can cause numbness and tingle in the extremities. People with peripheral neuropathy are often unaware of blisters and wounds on their feet. High blood sugars make wound healing delayed so that this combination can spell disaster for the feet.

  • Inspect your feet regularly for calluses, which can have deep blisters underneath, as well as wounds. If you have thick calluses, it’s best to have them evaluated by a healthcare professional. If you attempt to scrape away at the calluses, you may injure the tissue beneath it and increase the risk for injury and infection.

  • Ensure you have properly-fitting shoes for exercise, as ill-fitting shoes can cause blisters and sores. Many insurance companies cover the cost of special therapeutic diabetic shoes. You can also ensure a proper fit by choosing a certified therapeutic shoe fitter.

Conclusion

Being physically active is extremely beneficial for overall health. It’s especially helpful for people with diabetes as exercise helps to improve insulin resistance, lower blood sugar, and reduce the risk of long-term diabetes complications.

There are different forms of physical activity, such as aerobic exercise, weight lifting, and balance exercises.

All of these forms of activity are beneficial for people with diabetes and have proven health benefits.

It’s best to choose a type of physical activity that is enjoyable for you, and that matches your fitness level and any physical or health limitations you may have.

There are precautions people with diabetes should take before exercising. Checking blood sugar before and after exercise choosing proper shoes for foot health, timing your meals and snacks to prevent hypoglycemia are all smart steps to take when adding exercise to your diabetes self-management plan.

Sources

  1. University of Birmingham. “Physical exercise reduces risk of developing diabetes, study shows.” ScienceDaily. ScienceDaily, 20 February 2018.
  2. Way KL, Hackett DA, Baker MK, Johnson NA. The Effect of Regular Exercise on Insulin Sensitivity in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Diabetes Metab J. 2016;40(4):253–271. doi:10.4093/dmj.2016.40.4.253
  3. Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33(12):e147–e167. doi:10.2337/dc10-9990
  4. Hamasaki H. Daily physical activity and type 2 diabetes: A review. World J Diabetes. 2016;7(12):243–251. doi:10.4239/wjd.v7.i12.243
  5. Kennedy ANarendran PAndrews RC for the EXTOD Group, et al
    Attitudes and barriers to exercise in adults with a recent diagnosis of type 1 diabetes: a qualitative study of participants in the Exercise for Type 1 Diabetes (EXTOD) study

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