DIABETES AND EXERCISE

The image of the muscular athlete, bathed in sweat, receiving the gold medal, is deceptive. Exercise, the pursuit of physical fitness, is not just for Olympians and professionals. Ancient Greek physician Hippocrates of Kos taught that a well-balanced lifestyle, with proper diet and appropriate exercise, was good therapy.

But we seem to have lost something since that time. In our worship of convenience and pursuit of the latest technology, we forget that sometimes the old ways were good for you! Almost nobody gets enough exercise these days--but this lack is more critical if you have diabetes.

Whether you have Insulin-Dependent or Non-Insulin-Dependent Diabetes (IDDM or NIDDM, type 1 or type 2), the end result is an oversupply of undigested glucose in the blood. This leads to hyperglycemia, and opens the door to a whole host of serious, possibly life-threatening complications. "Good diabetes control" consists of getting your blood glucose numbers down into the safe range, and keeping them there.

Exercise burns blood glucose. It is so effective that, coupled with proper diet, it forms the basis for certain types of diabetes therapy, the "diet and exercise" regimes followed by many type 2 diabetics. But exercise is not just for these folks.

No matter what type or degree of diabetes you have, regular physical exercise helps protect against hyperglycemia and ramifications, possibly lessening your need for insulin and/or oral medications. To the degree that it leads to weight loss, and to maintenance of ideal weight, it can cut insulin resistance, leading to a reduction in the need for medication. It lowers blood cholesterol, reducing the risk of heart complications, and it cuts stress, keeping down the adrenalin level, which improves diabetes control. Enough reasons?

Many folks act as if exercise requires one to be fit before commencing--as if the benefits must precede the act. "Oh, I can't do that; I'm not in shape." This belief is unfounded. Regardless of level of fitness, and regardless of ramifications, a program of regular physical exercise will be of benefit. Talk to your doctor; then you and your health care team can plan a realistic program that is appropriate for you.

What can you do? Although a lucky few get to work out in well-equipped gyms, they are not a requirement. Walking, with dog or cane, is high-quality exercise, and requires only a route to follow and the motivation to do so. Swimming provides a full-body workout, while minimizing "impact," repetitive stress to the joints. If you are in a manual wheelchair, you already know what a quality workout it can provide! If you use an electric wheelchair, you merely have to be a little more creative.

A variety of home exercise equipment is available: treadmills, exercise bikes, rowing machines and lifting machines. According to your individual circumstances, one or more of these may be appropriate for you.

Good exercise regimes are as varied as the people who follow them. A number of exercise physiologists have workout routines for folks who must remain seated while exercising, and your health care team should be aware of such. Several are available as videocassettes. Exercise while chairbound, or dealing with an amputation, should present no more challenge than does getting dressed.

There is one special consideration for diabetics who exercise: As exercise burns glucose, hypoglycemia, low blood sugar, becomes a possibility. Diabetes is a balancing act between too high and too low, and exercise drops the numbers. Take your glucose monitor with you; test before you start, and use those results, and perhaps another test part way through a prolonged workout, to determine if you need a snack. Test again after you've finished.

As you learn your own individual responses to specific types and amounts of exercise, you can better balance food and insulin intake. If you take along a source of quick sugar (glucose tablets, orange juice, lifesavers, cake-icing, etc.), you should be able to immediately respond to steep drops in your blood glucose, and keep yourself out of danger. Remember to talk to your doctor about adjustment of insulin dosage.

The ability to "feel" an oncoming insulin reaction varies from person to person. Some folks have little problem; when they feel "shaky," they have a snack. Others have greater or lesser degrees of "hypoglycemia unawareness," the inability to feel an oncoming "low." For these individuals, especially those who can't detect a low until they are almost unconscious, frequent glucose monitoring, rigid attention to schedule, and perhaps "buddy system" exercise can provide the needed margin of safety.

There are other ways to improve your safety. If you are walking or jogging, wear properly fitted athletic shoes of good quality, with appropriate athletic socks. Afterwards, check your feet for blisters, bruises, or any other damage. If you are working out in public, wear appropriate medical identification, and if there is any doubt about your visibility to passing drivers, wear bright clothes. Remember to give yourself a warm-up before, and a cool-down after your workout. Having an exercise partner is a good idea--it also spurs your motivation!

The word "exercise" comes from an old Latin word meaning "training." The Romans knew that to have value, an exercise program had to be disciplined--regular actions and regular schedule. Once you have established your workout routine, follow it! Confer with your healthcare team first; set realistic goals, and then stick with it.