Audrey Demmitt, RN, BSN, is a nurse diabetic educator, VisionAware Peer Advisor, AFB Career Connect mentor, and author of the VisionAware multi-part blog series on diabetes and diabetes education. At age 25, Audrey was diagnosed with retinitis pigmentosa and continued to work as a nurse for 30 years with her visual impairment.
She has worked as an Adjustment to Blindness Counselor and Diabetic Educator for Vision Rehabilitation Services of Georgia and as a school nurse providing in-service training for school staff and developing care plans for newly-diagnosed students and their families.
In Part 1 of her series, Audrey discussed how diabetes education can help lower your blood sugars and reduce the risk of diabetic retinopathy. In Part 2, she emphasized the significance of the A1C test in the effective diagnosis, treatment, and management of diabetes. In Part 3, Audrey explained the importance and benefits of healthy eating as part of a comprehensive diabetes care plan.
In this month’s installment, Audrey discusses the importance and benefits of exercise as a critical component of a comprehensive diabetes care plan. As Audrey says, “Remember this when it comes to exercise: If you are doing nothing, do something. If you are doing something, do more!”
The Importance of Exercise
Exercise is an essential part of the diabetes management plan. There are many benefits to incorporating this healthy habit into your diabetes care. It is an effective way to lower your blood sugars and, over time, lower your A1c. In the long term, regular exercise can protect you against many of the serious complications of diabetes: heart disease, retinopathy, neuropathy, and kidney failure.
According to the American Diabetes Association, regular physical activity:
- lowers blood pressure and cholesterol
- lowers the risk for heart disease and strengthens your heart
- improves blood circulation
- burns calories to help you lose or maintain weight
- increases your energy for daily activities
- helps you sleep better
- relieves stress
- strengthens your muscles and bones
- keeps your joints flexible
- improves your balance to prevent falls
- reduces symptoms of depression
- improves your overall quality of life
Exercise and Blood Sugars
There are two ways that exercise lowers blood sugars:
- When you are exercising, your cells become more sensitive to available insulin, which helps your cells to take up blood glucose during and after the activity.
- When you contract muscles, another mechanism is activated that allows cells to use blood glucose for fuel without the need for insulin.
The American Diabetes Association recommends a combination of aerobic forms of physical activity and strength training for maximum effect:
- Aim for at least 30 minutes of moderate-to-vigorous aerobic exercise five days a week: brisk walking, dancing, and swimming.
- In addition, try to do strength training activities two days a week: using weights, resistance bands, or doing exercises that use your own body weight to work your muscles, such as push-ups or sit-ups.
Safety Tips for Getting Started
- Consult with your doctor before getting started. There may be special considerations and precautions to take if you have known complications, such as heart disease, neuropathy, and visual impairment. You can still exercise, but you may need to adapt your routine. A personal trainer, physical therapist, or vision rehabilitation professional can help you pick safe activities. Your doctor can help you coordinate your exercise plan with your diet and medications.
- Wear a medical alert ID while exercising. You can purchase these IDs at a drugstore or medical supply store or order an ID for free at the Diabetes Research and Wellness Foundation website.
- Start slowly and gradually increase your activity. Begin with a walking program. Try exercising in 10-minute intervals at first. If you are pressed for time, you can do 15 minutes in the morning and 15 minutes in the evening. Easing into regular activity helps to avoid injuries and muscle soreness from doing too much too soon.
- To learn how your body responds to exercise, check your blood sugar before, during, and after your activity when first starting a new routine. Ask your doctor what guidelines to follow with respect to your blood sugar levels. Generally, it is safe to exercise when your blood sugar is between 100mg/dl and 250mg/dl. You may need to eat a snack with 15-20 carbohydrates if you are below 100mg/dl. Postpone your workout if your blood sugar is higher than 250mg/dl and monitor your urine for ketones until it returns to a safe range. Exercise can lower your blood sugar for up to several hours after the activity. The harder and longer the workout, the longer it can affect your blood sugar afterward; therefore, check your blood sugars after exercise too. Discuss any patterns of concern with your doctor.
- Be prepared to treat low blood sugar symptoms while exercising. Carry your glucometer and a fast-acting carbohydrate snack to correct a low blood sugar episode. Stop exercising if your blood sugar is 70mg/dl or below or you feel shaky, weak or confused. Eat 3-4 glucose tabs, ½ cup fruit juice or 5 hard candies to raise your blood sugar and recheck in 15 minutes. Repeat as needed. You can resume your workout once your blood sugar returns to a safe range. For more information, see Hypoglycemia and the 15/15 Rule and Watch for Symptoms of Low Blood Sugar.
- Keep a routine with meals, exercise and medication times. Maintaining consistency can help control your blood sugars and prevent highs and lows.
- Work out with a friend who knows you have diabetes. Be sure your friend knows what to do if you have symptoms of low blood sugar. The buddy system will also help keep you encouraged and motivated.
- Wear clean socks and well-fitting shoes that match the activity. Be sure to check your feet for irritations, cuts, blisters or sores when starting an exercise routine. To avoid serious infections, wash your feet daily and report any new foot problems to your doctor.
- Drink water before, during and after exercise to maintain hydration. Dehydration can cause your blood sugar levels to rise. Drinking water can bring blood sugar down when it is elevated.
- If you experience sudden pain, stop what you are doing. Some muscle soreness can be expected, but pain is not normal. Pain is your body’s way of warning you that something is wrong. If a movement hurts, don’t do it. If you experience chest pain, shortness of breath, or other cardiac symptoms, call 911 immediately. Carry your cell phone for emergencies while exercising.
- Have fun with fitness and enjoy the benefits. Remember, when it comes to exercise, “If you are doing nothing, do something. If you are doing something, do more!”
Be sure to read Part 5 in this series, Ways to Make Monitoring Blood Sugar Easier, More Accurate, and Less Costly.