There are a few things that are really important to consider as a diabetic when exercising.
The biggest problem, as mentioned previously, is hypoglycemia (blood sugar <70 mg/dL). Those most at risk of developing hypoglycemia are those of you taking insulin or oral drugs that increase insulin secretion, such as sulfonylureas. Unfortunately, hypoglycemia is relative and symptoms may be present due to rapid drops in blood sugar, even if levels are well above 70 mg/dL. Symptoms of hypoglycemia include: shakiness, weakness, abnormal sweating, nervousness, anxiety, tingling of mouth and fingers, and hunger. Conversely, you may experience no symptoms as blood sugar levels rapidly decline with exercise.
When there is a shortage of glucose to the brain (called neuroglycopenia, a big concern because the brain's main source of fuel is glucose), symptoms include: headache, visual disturbances, mental dullness, confusion, amnesia, seizures, and coma.
It is important to be aware that hypoglycemia and its effects may delayed up to 12 hours after exercise, so monitor blood sugar levels closely before and for several hours after exercise. This is especially important if you are new to exercising. For diabetic exercisers, it is critical to exercise with a partner to reduce the risk of complications due to hypoglycemia.
Timing is of utmost importance with diabetes and exercising. If you use insulin, you made need to change timing, dosage, and carbohydrate consumption to prevent hypoglycemia from occurring during or after exercise. Those of you not on insulin will also need to adjust carbohydrate and medication intake before and after exercise based on your blood sugar level and exercise intensity to prevent hypoglycemia. For nearly all of you, modification will require physician supervision and experimentation to help determine exactly how your body reacts to new combinations of drugs and exercise.
Monitoring blood sugar for extended periods of time will be useful in determining the patterns of blood sugar levels and both immediate and long-term effects of exercise. This will ultimately allow you to fine-tune your carbohydrate and medication intake before and after exercise.
If you have Type 1 DM, hyperglycemia can be a problem if you do not have controlled blood sugar levels. Symptoms of hyperglycemia include: excessive urination, fatigue, weakness, excessive thirst, and acetone breath (a fruity odor). If you are hyperglycemic with no symptoms or ketone bodies (ketone bodies are the by-products of breaking down fats for energy) present in the blood or urine, you may exercise, but be sure to check blood sugar often and do not partake in vigorous-intensity exercise until blood sugar goes down.
If you are hyperglycemic and urinating frequently, you are at an increased risk of developing a heat-related illness and should be monitored closely for the signs and symptoms of that, as stated by the CDC. Take special note of their tips for people with chronic medical conditions.
Having DM and retinopathy puts you at an increased risk of retinal detachment and vitreous hemorrhage. Avoid exercise that dramatically elevates blood pressure. If you have severe diabetic retinopathy, you should avoid both vigorous aerobic exercise and resistance exercise.
If you have peripheral neuropathy (damage to nerves going out from the brain and spinal cord to arms, legs, hands, feet, etc.), be sure to take proper care to prevent ulcers and blisters on your feet, since you will be less likely to feel them forming. Keep your feet dry and use shoe inserts and absorbent socks.
Lastly, as an individual with DM or prediabetes, you are at a high risk for, or possibly even have, cardiovascular disease (CVD). As such, you should take even greater care to progress exercise slowly and be sure to listen to whatever your body is telling you (most especially if you are experiencing the signs and symptoms of heart attack or stroke, as outlined by the NIH's branch the National Heart, Lung, and Blood Institute).
Unfortunately, there are a lot of precautions to take before exercising. However, there are plenty of benefits, as outlined in my previous post "Exercise Prescription for Diabetics", the most exciting of which is that Type 2 DM can be prevented, and sometimes reversed, if a regular exercise program is started early enough.
Thanks for reading!
-Emalee
Information for this blog came from the ACSM's Guidelines for Exercise Testing and Prescription, 9th edition (2014) and the websites for the Centers for Disease Control and Prevention and the National Institutes of Health.
Lastly, as an individual with DM or prediabetes, you are at a high risk for, or possibly even have, cardiovascular disease (CVD). As such, you should take even greater care to progress exercise slowly and be sure to listen to whatever your body is telling you (most especially if you are experiencing the signs and symptoms of heart attack or stroke, as outlined by the NIH's branch the National Heart, Lung, and Blood Institute).
Unfortunately, there are a lot of precautions to take before exercising. However, there are plenty of benefits, as outlined in my previous post "Exercise Prescription for Diabetics", the most exciting of which is that Type 2 DM can be prevented, and sometimes reversed, if a regular exercise program is started early enough.
Thanks for reading!
-Emalee
Information for this blog came from the ACSM's Guidelines for Exercise Testing and Prescription, 9th edition (2014) and the websites for the Centers for Disease Control and Prevention and the National Institutes of Health.
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