Actively manage diabetes.
For people with diabetes, in addition to being careful about diet, staying on the move is crucial to control blood sugar and reduce the risk for developing complications related to the chronic condition. "There is overwhelming evidence for the beneficial role of both physical activity and more structured exercise programs in the management of both Type 1 and Type 2 diabetes," says Dr. Roeland Middelbeek, a staff physician and research associate at Joslin Diabetes Centre in Boston. Besides helping keep blood glucose and weight in check, research finds regular exercise can reduce cardiovascular risks -- which tend to be higher for people with diabetes -- and decrease the need for insulin, particularly in people with Type 1 diabetes.
Know what's recommended.
Standard physical activity guidelines apply for people living with diabetes. "Most adults with diabetes should engage in 150 minutes or more of moderate-to-vigorous intensity activity weekly," according to the American Diabetes Association. This could range from brisk walking to cycling to swimming or running, depending on the person's level of fitness, spread across the week. Besides aerobic exercise and resistance training, like lifting weights or using machines or body weight for resistance, the ADA also recommends flexibility training and balance training. "Yoga and tai chi may be included based on individual preferences to increase flexibility, muscular strength and balance," the ADA notes. Kids should get 60 minutes of physical activity daily. That includes engaging in muscle- and bone-strengthening activities on three days.
Consult your doctor.
Those who have been inactive for a longer period -- especially, say, for years -- or who have any diabetes-related symptoms or complications or any other medical concerns, as well as older adults, should talk with a doctor before starting a new exercise regimen. Ideally, talk with the health provider you see regularly for diabetes about any restrictions you should follow or other advice. It's not only about making sure diabetes is controlled -- where exercise is, of course, a big help -- but also making sure other heart disease risk factors like blood pressure and cholesterol are under control before starting strenuous activity, says Dr. Elizabeth A. Stephens, an endocrinologist and medical director of diabetes education for Providence Medical Group in Oregon.
Check blood sugar often.
Blood sugar levels can fall or rise while working out -- and even flux long afterward. If it's too low or high, that can spell trouble. Hypoglycaemia, or low blood sugar, for instance, can cause issues ranging from drowsiness, shakiness and feeling lightheaded to confused thinking and, if not addressed, even more severe problems like seizures. "The challenges related to blood glucose management vary with diabetes type, activity type and presence of diabetes-related complications," the ADA notes. So it's best to discuss with your doctor what's the optimal blood glucose range for you to begin exercising. You should also ask about strategies for keeping blood sugar in that range -- from what you should eat before exercising, to having quick-acting sugar sources like glucose tablets or snacks on hand while exercising.
Stay well hydrated.
For those with diabetes, dehydration can be more common, in part because the body is trying to pee out excess sugar. Water is typically the first -- and best -- choice for hydration before, during and after working out. For athletes with Type 1 diabetes who are exercising for longer than 45 minutes, sports drinks with carbs and electrolytes may prevent low blood sugar, according to a 2017 research review on exercise and Type 1 diabetes published in The Lancet Diabetes & Endocrinology. However, the authors caution that guzzling too many sports drinks can result in high blood sugar, or hyperglycaemia. The review also notes that milk-based drinks with carbs and protein can help with recovery after exercising. Drinking whole milk can help in avoiding hypoglycaemia while not causing excess increases in glucose after a workout.
Make accommodations for diabetes complications.
In some cases, diabetes complications make staying active more challenging. For instance, diabetic neuropathy, or nerve damage, can cause numbness in the legs and feet -- so a person may not initially notice a blister or foot ulcer, notes Michael Riddell, a professor of kinesiology and health science at York University in Toronto, and the lead author of the Lancet review. Nevertheless, clinicians stress that the benefits of activity generally still far outweigh the risks for those with diabetes complications. "But they have to proceed a bit more cautiously, getting screened by the physician, checking the nerves, checking the feet," Riddell says. Similarly, consult a doctor about other complications like retinopathy, a disease of the retina that's sensitive to increases in blood pressure, which may be reason to avoid exercises like heavy lifting.
Forge thoughtfully ahead.
The point of taking a thoughtful, safe approach to exercise with diabetes isn't to stall activity. Rather, experts say, it's quite the opposite: to ensure people with the chronic condition can reach their fitness goals, and realize the profound benefits of improved health, longevity and quality of life. "I think that we all should challenge ourselves a little bit at any age, whether you're 20 with this disease or whether you are 65 or 70," Riddell says. "Exercise should be fun and it can be really fun, and just having diabetes doesn't preclude you from doing the things that you want to do," Stephens adds. "It just takes a little bit more preparation."
To recap, here are ways to safely exercise with diabetes.
-- Know what's recommended.
-- Consult your doctor.
-- Check blood sugar often.
-- Stay well hydrated.
-- Make accommodations for diabetes complications.
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