As diabetics we do tend to exercise at the same time each day and try to use the same number of calories so that we don’t have to cope with that dreaded hypoglycemic attack. Some times I think that my glucose tablets and I are joined at the hip, as I never exercise without some in a pocket.
Having said all of this, why do I exercise every day? The answer is easy. I want to build a stronger heart and circulatory system. Exercise can lower blood pressure and increase the production of HDL, the good lipoprotein that we measure when we get our cholesterol measured. If you have read our articles on the subject, you know that it is HDL that helps clear other cholesterol from the blood and which protects against heart disease.
Why should a NIDDM, or type 2 diabetic, exercise? Insulin resistance, which is a major cause of type 2, may be responsible for as much as 25% of the cardiovascular disease seen in men and 60% of that seen in women as per the 1996 American Diabetes Association scientific conference. Insulin resistance, as you will remember, is a condition in which a person’s body makes enough insulin, but cannot use it efficiently to metabolize sugar in the diet. The result is high insulin levels and often high blood-sugar levels.
Insulin resistance and abdominal obesity – which is found in most people diagnosed with type 1 diabetes – can result in high and abnormal insulin amounts in the blood glucose levels. Triglyceride levels can rise to unhealthy levels and HDL cholesterol can decrease contributing to atherosclerosis. In addition, insulin resistance can lead to high blood pressure which also contributes to the development of atherosclerosis.
We get many questions about exercise and the necessity of it. For people with diabetes and those who have or at high risk of heart disease, infrequent, strenuous exercise can strain muscles and the circulatory system, thereby increasing the risk of a heart attack during exercise. In addition, doing strenuous exercise for six months and then stopping isn’t as effective as a regular, long-term exercise program.
Let’s examine the known results of exercise. For IDDM or type 1 diabetes, exercise has not shown to exclusively improve glycemic control. However, keep reading. Type 1 diabetics need to exercise to improve cardiovascular fitness and psychological well-being. Doctors believe that safe participation in all forms of exercise, consistent with your life-style, should be a primary goal for IDDM.
All of us with type 1 know the risks of exercise and guard against them. These include hypoglycemia, hyperglycemia, ketosis, cardiovascular ischemia and arrhythmia, exacerbation of proliferative retinopathy, and lower extremity injury. Because it is difficult to manage insulin administration, meals, and the effects of exercise, it is important that type 1 diabetics monitor blood glucose levels. All that being said, nothing else will make you feel better and protect you for years to come.
For type 2 diabetes exercise is an adjunct to diet and/or drug treatment to control glycemic control, reduce cardiovascular risk factors, and increase psychological well-being. Persons most likely to respond favorably are those with mildly to moderately impaired glucose tolerance and hyperinsulinemia. This recommendation is based on the premise that benefits of exercise outweigh the risks. However, attention must be paid to minimizing potential exercise complications.
Now for the meat of this article. Come winter many of us will not be outside exercising as often as we would wish. As a type 1 diabetic who had open heart surgery in my 40’s, I do not do strenuous exercise when it is very hot or cold outside so that I do not stress my cardiovascular system. Here I want to share with you two types of exercise that I turn to in the winter. The first is one of my favorites when we visit the mountains of Colorado and the weather is more temperate. This is cross country skiing. Now, I should share with you that I began cross country well before I became diabetic.
When we lived in Washington, DC, we often skied the streets during a storm and more than once, skied to a market for some very important ingredient when school was out of the question and baking was the activity of the day. When you go to a ski resort, you will find groomed trails over varied terrain. Your skis will be long, thin, and light to carry. Your boots are secured to these skis by bindings that allow your heel to lift up while you ski. The result is gliding over the snow as you move quietly through the landscape. One of the reasons I took up this exercise was that this is an excellent full body aerobic workout which is low risk. I do down hill ski and one of the good things about cross country is no lines and falling down a mountain, or hitting trees when you lose control.
It is certainly a cardiovascular conditioner and burns lots of calories. But wait. The best thing about cross country in a big ski resort, is the price. A group lesson and ski rental will cost about $35.00 rather than the hundreds it will cost you for downhill. The trouble with cross country is that you need snow. If you go to many resorts they will make snow for downhill slopes. This is not so on the golf course where you may find the cross county trails. This is a sport where layering your clothes is important. When you start out you may feel cold, but believe me, you will get warm, quickly. The layer closest to you should trap body heat and absorb moisture as you will sweat. The outermost layer should be breathable, yet water and wind resistant.
So what will you need? Skis, boots, and poles. If you are a beginner and renting, get waxless skis so you don’t have to carry different colored waxes for different conditions. One last reason to try this wonderful sport this winter is that it is very easy to learn. After a very few minutes of lessons, you will most likely have the motion and rhythm of cross country. Learning different skills for more difficult slopes can come next. We used to ski up Vail Gore and ski down the side after a really nice lunch at the top. No groomed trails here, but more fun than I can express. An instructor is a good idea if you are thinking of doing this, but a friend who cross countries and understands diabetes can take you on level trails. Make sure you look up while you cross country. You won’t believe the beauty around you.
My second exercise is the one I do when I can’t go outside in the winter. This is circuit training. I like this when I need an aerobic workout and it’s much too cold for me do this outside. So, what is this? It’s a fast-paced weight training program where you move from station to station and exercise to exercise – sometimes running – without taking a break. Sometimes we do step with weights as part of the program, sometimes we sit on the step and do curls, sometimes we vary the stations so we are never bored. With a group, this if fun. If you’re short on time, this is a good choice because after a warm up, the exercise is intense and therefore can be shorter than a regular workout.
Cool down and then get back to the office. Now for the down side of this type of exercise. Although you’ll build moderate amounts of strength and burn calories, it’s not as good as other exercises such as slower, heavier strength training for building strength, and traditional aerobic workouts which are better for burring calories and improving your cardiovascular fitness. To build in aerobic exercise, alternate one minute of an aerobic exercise such as jump rope, stepping or stationary cycling with 15 reps of a weight-training exercise. What ever you do, don’t forget to take your heart rate every 10 minutes or so, or at least rate your effort on a scale of 1-10 so you don’t over or under do it.
Many gyms have a circuit of weight machines so you simply move around the gym from one machine to the next.
What will you need to do this type of exercise? You need regular workout clothes and a way to measure your heart rate or effort level. At the gym you will need weight machines, free weights, and any other type of equipment that can be used for weight training. For aerobic training you can use steps, jump ropes, boxing bags etc. This is an exercise program you can do at a gym or home. For example, if you have free weights and a large exercise ball or a medicine ball you can make up a program for yourself at home.
These are just a part of an exercise program. Do other exercises to keep your flexibility intact. Make sure you have exercises that are aerobic, some that develop muscular strength and some that help with your endurance. Do know your resting heart rate and blood pressure. Meet with your health care team members to set up goals that are right for you. Don’t do too much too fast as this is a common problem with many people who are just beginning. Moderation is the right way to go. You can have musculoskeletal injuries or even worse.
The signs of over use can occur weeks or days after the injury. A sound program that is made for you will help make sure you are on the right track. Also proper rest between exercise sessions will allow you to recover from the demands on your body. If you do aerobic exercise, one day, go to weights the next and then do flexibility the next. Endurance exercises can be the next and then start again.
Know the symptoms of an insulin reaction or hypoglycemia if you take certain oral agents. Stop immediately and get out those glucose tablets. If you don’t have your meter with you – and you should, you know, take the extra calories and when you get home put an extra glucometer in your gym bag after you check your blood glucose level. It’s winter. Make sure you keep your skin from drying out. Ask your doctor what to use if your skin gets too dry, otherwise over the counter products can be of use. Whatever you do, don’t stop exercising just because it’s cold. You’ll be a healthier, happier person and you’ll be able to visit with us for years.