Diabetes & Exercise

Diabetes and exercise

Exercise is being increasingly promoted as part of the therapeutic regimen for diabetes mellitus. In addition to its cardiovascular benefits, exercise can improve glycemic control by increasing the tissue sensitivity to insulin due to the weight loss.

Screening before exercise:

Before we conduct an exercise program to the diabetic patient, they have to undergo detailed medical evaluation with appropriate diagnostic studies. This aims to screen whether there is any presence of macrovascular and microvascular complication as it may be worsened after the exercise program. 

The examination of complications including:

•          Cardiovascular system
•          Retinopathy
•          Neuropathy (autonomic and peripheral)
•          Peripheral artery disease
•          Nephropathy

Preparation before Exercise and After Exercise

Table 1: What we should do before, during and after exercise (Adapted from Canadian Journal of Diabetes. 2006;30(1):63-71)

Type 1 DM

Type 1 diabetic patient can engaged with all levels of exercise such as:

•         Leisure activities 
•        Recreational play
•        Competitive sport

However there are some limitations or guideline to do any physical activities among people with type 1 DM. This is to make sure that the beneficial of exercise is achieved without any problems and complications besides well monitoring blood glucose level. 

There are certain types of exercise to avoid due to complication occur in diabetic patients such as: 

·         Heavy weight-lifting

Ø  Extra pressure on the blood vessels in your eyes ( diabetic patient with eye problem)

·         High-impact exercises

Ø  Should be avoided when having nerve damage. 

Type 2 DM

As we know, exercise gives benefits to both children and adult with type 2 diabetes. In general, your exercise program should include a balance of:

• DO Aerobic exercise (walking, running and swimming). This can increase your heart rate and deepen the breathing. 

 

• DO strengthening exercise. This is to have better balance and strengthen your bones.

• DO regular stretching. This is to increase your flexibility and can prevent from muscle soreness due to aerobic or strengthening exercises. 

Table 2: Summary of exercise prescription for type 2 DM patient (Adapted from American Heart Association, Thomas et al, 2009).

Table 3: Things to do for patient that taking insulin injection and ODA should do before exercise.

# For GDM

Exercise is not necessary as a part of treatment. However, it may help to   control their blood sugar levels. If pregnant mother were exercising before, so they should continue it after being diagnosed by GDM. If they don’t exercise before, ask the physicians. Mostly, women without complication are able to exercise at least moderately.

Exercise effects on diabetic patients

Diabetes mellitus is a type of disease that has grown worldwide. There are certain goals of exercise for DM patients in terms of improving health and fitness which are:

      1)      Cardiovascular endurance

      2)      Strength

      3)      Body fat composition

Besides that, by doing an exercise, it also can increased confidence level, socialization and healthier lifestyle attitude. Table below stated some of physiological effects of exercise in diabetic patient below:

Table 4: Physiological effects of exercise for diabetic patient.

References:

http://www.simplefitnesssolutions.com/articles/diabetes.htm

http://health.nytimes.com/health/guides/specialtopic/physical-activity/exercise's-effects-on-diabetes.html

http://www.uptodate.com/contents/diabetes-mellitus-type-2-alcohol-exercise-and-medical-care-beyond the-basics

http://www.pennmedicine.org/health_info/diabetes1/000266.html

http://www.everydayhealth.com/diabetes-type-1/managing-type-1-diabetes.aspx

http://www.gymcompany.co.uk/blog/2012/this-week-is-national-diabetes-week-how-exercise-can-help

http://www.uptodate.com/contents/gestational-diabetes-mellitus-beyond-the-basics

Tamborlane WV. Triple jeopardy: nocturnal hypoglycemia after exercise in the young with diabetes. J ClinEndocrinolMetab. 2007;92:815-816.

Thomas et al,. Exercise Training for Type 2 Diabetes Mellitus, Circulation, 2009; 119: 3244-3262