Diabetes and Exercise

Awhile back a friend who also is a personal trainer asked me for some information on diabetes and exercise. Knowing that he couldn't possibly be the only person interested in this, I decided to make a whole post dedicated to this topic. Most of the information in here is quite general. If you have questions, feel free to leave me a comment and I will answer them. This post is not meant to diagnose or treat diabetes (or any other disease), it is merely informational and perhaps inspirational to get someone to move a little more. For more information, please refer to a physician, a diabetes educator, or visit diabetes.org.

(A Very Brief) Overview

In 2011 it was estimated that over 25 million U.S. citizens are believed to have diabetes. Of that number 18.8 million people were diagnosed while approximately 7 million people were currently undiagnosed. That was 8.3% of the U.S. population in 2011, almost 10% of us!

There are two main types of diabetes. These are referred to type 1 and type 2 diabetes (think Thing 1 and Thing 2 from Dr. Seuss books). In both types of the disease the body has trouble utilizing glucose (i.e. fuel) in the blood. Typically in a person without diabetes, when blood glucose levels increase (which generally occurs after a meal) insulin is produced and released by the pancreas which activates cells to transport glucose into cells via transporters and the glucose can be used in the cells for energy or stored for future use.  

Thing 1 and Thing 2 are far more pleasant than type 1 and type 2 diabetes. 

Type 1 vs. Type 2

In type 1 you do not produce insulin, so when blood glucose rises there is no signal that cells need to move transporters to the cells' surface to take in glucose. When this happens blood glucose can remain high and cause a litany of complications. In addition, when your body is unable to use blood glucose it causes the body to think it is starving and it then resorts to other sources of energy. This can lead to muscle breakdown and excessive utilization of fat stores (which can lead to a dangerous complication known as ketoacidosis). In type 1 diabetes, patients are prescribed insulin to help the body move glucose into cells.

In type 2 diabetes your body still produces insulin but your cells do not react to it as well, this results in glucose utilization by cells being lowered. This also results in high blood glucose levels and can result in complications. In type 2 diabetes, patients are not usually given insulin since their body can still produce it. Instead, patients can be given drugs to increase insulin production, to lower glucose release by the liver, and /or to make cells more sensitive to insulin. In addition to prescription drugs, type 2 diabetes can be managed through a healthy diet and exercise.

Diabetes and Exercise

In both forms of the disease, blood glucose levels should be monitored pre-, during, and post- exercise. If blood glucose levels are above 250 mg/ dL, the urine should also be checked for ketones (if they are present it could indicate ketoacidosis). Monitoring pre- exercise will let one know if they ready to exercise. For instance, it is not recommended a person with diabetes and blood glucose level above 250 mg/ dL with ketones present exercise. However, a person with diabetes and a blood glucose level above 250 mg/ dL without ketones could initiate exercise. Blood glucose levels should be monitored throughout exercise, especially if the workout is longer than 60 minutes.    

Type 1 and Exercise

In people with type 1 diabetes, exercise can be a balancing act. Caution and careful blood glucose monitoring should be used when beginning an exercise program.  People with type 1 diabetes will need to find the perfect balance of eating enough carbohydrates to fuel their workout while using enough insulin to be able to utilize the glucose. 

Too many carbohydrates and not enough insulin can lead to hyperglycemia (high blood glucose) which can lead put one at risk for complications associated with uncontrolled diabetes. Too much insulin and not enough glucose can lead to hypoglycemia (low blood glucose). Risk of hypoglycemia is highest during and post- workout. To counteract hypoglycemia, additional carbohydrates should be consumed and blood glucose levels should be monitored. It can take time to adjust one's diet when beginning an exercise program, so it is best to check blood glucose levels consistently when starting an exercise program to find what works best. 

Type 2 and Exercise

Unlike type 1, people with type 2 diabetes will typically not need to balance blood glucose by using insulin. In fact, people with type 2 diabetes can potentially control* the disease with exercise. Exercise alone can make the cells more sensitive to the blood glucose, meaning the cell's glucose transporters can move to the edge of the cell to transport glucose into it to be utilized. With time, the need for some medications prescribed for type 2 diabetes may be diminished if not eliminated.

(* Please note that I used the word control, there is currently no cure for diabetes.) 

I hope this short run down of diabetes and exercise gave you some insight into what to pay attention to as well as a sense of what direction to go. As with any exercise program, please consult with a physician before beginning.        

Weighting for Change

There it is, that magical date on your calendar. May it be a wedding, school reunion, post-baby date, beach trip, etc.; you have a date and a goal in mind.

"I need to lose X pounds by (this date) and then my life will be perfect."

Next thing you know you're paying more attention to infomercials for battery operated waist bands that do your work out for you while you sit. Dr. Oz suddenly has you mesmerized and whatever flies out of his mouth is the God-given fact to weight loss. You stand in GNC/ Vitamin Shoppe/ (Insert your supplement store of choice here) in awe of your options for fat-blasting aids and metabolism boosters. These are the answers you have been looking for! These will finally help you lose that pesky weight you have carried for so long!

At least that's what you think.

But why invest your money in pills with more ingredients than what goes into a loaf of bread? Why strap and battery powered belt yourself? Why put the stress of one, inconsequential day on yourself?

Setting a date/ goal is a preliminary step in weight loss. But having just that and no real idea of what it takes to lose weight will only set yourself up for failure. And no, buying pills and products does not count as a plan. These are "quick fixes" if they deliver what they promise. But odds that it will last you a lifetime are not so high. The thing is, many of the products promise results in conjunction with a healthy diet and exercise!

I have seen/ heard from too many people who have said "I want to lose weight, I just don't want to change." (In all fairness, the phrase "I don't want to change" in its entirety was not stated. With that out there, the statement "I don't want to change the way I eat," or some variation of it, has been expressed.)

What You Need to Realize About Weight Loss

YES You will need to change. If you don't, how can you expect things to be any different?

"Insanity: doing the same thing over and over and expecting different results."- Albert Einstein.

NO You don't need the "latest and greatest" pill/ gadget to do it.

Someone once said "Your body is 80% what you put in your body and 20% what you do." Considering how far you have walk to burn off a doughnut, there is some truth to that.

NO You don't need to starve yourself. But...

DO Pay attention to what you're putting in your mouth; its the best place to start.

Tip: Look at the nutrition label to see what a serving size is and use that to put what you're eating in perspective. For instance, pour yourself a bowl of cereal. Then measure out a proper serving from the bowl you just poured with a measuring cup or a kitchen scale. How does this look compared to what you usually eat? Is there cereal left in your bowl or is the measuring cup coming up short? Do this for everything you eat for at least for a week. Some items you may be eating under a serving, but with others you may be eating double. Pay careful attention to items you are going over board with. Having too many vegetables isn't bad for the calorie bank, but too many chips can send you over your limit quick.

Pro Tip: Avoid eating straight from the package, things can quickly get out of hand. 

Image of the LoseIt! App

DO: Keep a log whether it be with pen and paper, on a website, or an application on your smart phone. This log can be not only for what you're eating, but for exercise too. There are a ton of options out there. Ones that I have personally used are Myfitnesspal.com and Loseit.com (both have apps and websites so you can update your log from just about anywhere).

Bonus: Most of applications out there can let you know how many calories you need to maintain, lose, or gain weight.  

DON'T Wait! Why put weight loss off for a special occasion? There may already be enough pressure on that special day, why add to it? Get out of the mindset of "now is not the time." My dad was diagnosed with type 2 diabetes two days before Thanksgiving. Two days, talk about "now is not the time." The holiday of gorging oneself was now him asking what he could eat and my mom scrambling to alter recipes. Chronic diseases don't wait for the "right time", why should you wait for the "right time" to be the healthiest you can be? Put yourself first and go after it!