by Peter J. Nebergall, PhD
"Get some exercise!" the doctor orders. Years of inactivity, maybe you're overweight, and your blood sugars need some attention. Diet and Exercise, they call it, lifestyle modification. You resolve to eat less, and you head for the gym.
They're great places, those neighborhood gyms. Packed with amazing gear, full of embarassingly-fit young people eager to show you how to use it all, just the ticket for getting those sugars down ... or is it?
Exercise cuts blood sugars. That's great, if they're too high. Low blood sugar, hypoglycemia, can be quick, dangerous, and possibly deadly. Who's vulnerable? All of us, but most of all, beginners.
Diabetics beginning exercise programs are often beginning diet and medication changes as well. Avoiding hypos while bringing your blood glucose down is a balancing act -- and many of the folks who show up at the gym, ready to give exercise a chance to "do its stuff," don't have a clue. We’re unfamiliar with our diet, our exercise, and our meds, all at the same time ...
"That's all right; the staff will be there," you say.
Uh-huh. Often as not, they don't have a clue. Do they know what to do for a "low?" Do they know what one looks like? Is there a blood glucose monitor somewhere for them to use? Has anyone on staff been trained what to do? Probably not.
In most cases, your "contract," your "membership," includes a "hold-harmless" clause as a prerequisite of joining. So if you have a hypo, you can't sue them. But, that doesn't bring your blood sugars back up, now, does it?
So, what do you need to do? First, accept that exercise, like your medications, is a powerful tool for lowering your blood glucose. It works. The problem is to control that lowering, to manage it.
Second, realize you probably know more about diabetes than the gym staff does. They probably won't recognize you're having a low, a reaction, and they may not have anything on hand to get you out of it. YOU should have that available yourself.
Do you have a blood glucose monitor? Can you get reliable results out of it? Do you know how far down your sugars will fall, during and after a workout? And, do you have something sugary (diabetes tablets, Lifesavers, NECCO candies, etc.) to take if you do get too low? You'd better.
Third, don't expect the staff to intervene. Sure they will, if you hit the floor, but they may well miss what's going on while you're on the way down. Why? They've not been trained for it.
The gym is not a hospital, and, though exercise is good for you, the staff are exercise trainers, not paramedics or diabetes educators. You may well have to educate them yourself.
Talk to the staff, and the manager, of your local gym. See what they know. If you are "brittle," or if you feel the need for more medical supervision, a number of local hospitals have "supervised" gyms, with trained medical people on staff, to serve the "cardiac rehab" people.
The other thing you can do, you should do, is realize it's your responsibility. Watch for those lows during and after exercise. Test often. Test when you're done, and if you're doing a long session, and you feel any doubt, take a break and test. And, test again, two or three hours later -- exercise keeps on lowering your blood sugar for up to 24 hours.
Exercise is wonderfully good for you -- if you're prepared. It's up to you!