Diabetes Mellitus and Exercise

What is Diabetes Mellitus? 

Diabetes Mellitus is a chronic condition  and occurs either because the body cannot produce insulin or the body can’t properly utilize the insulin that it does produce.  Insulin, a hormone that is produced in the pancreas, is needed by glucose (sugar) circulating in the blood in order to be transferred or pass into muscle or fat cells to be used as energy for cellular function.

There are 18.2 million people in the United States that have Diabetes, which is 6.3% of the population.  13 million people have been diagnosed, but another 5.2 million are undiagnosed and not even aware they have this condition. Diabetes is the 5^th deadliest disease in the United States . (American Diabetes Association).  The two major types of Diabetes Mellitus are Type I- Insulin Dependent Diabetes Mellitus (IDDM) and Type II- Non-insulin Dependent Diabetes Mellitus (NIDDM). 

TYPE I- IDDM:  (Insulin Dependant or Juvenile Diabetes):  The body does not produce insulin, 5-10% of population, usually diagnosed in children and young adults. Treatment is to carefully monitor blood glucose levels and utilize injections of insulin.

TYPE II-NIDDM: (non-insulin dependant):  Most common form of Diabetes, in which the body doesn’t produce enough insulin or ineffectively uses the produced insulin, resulting in complications of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).  Treatment can  simply be controlled diet and exercise or oral medications.

Diagnosing Diabetes is done is by the patient performing either a Fasting Plasma Glucose Test (FGT) or an Oral Glucose Tolerance Test (OGTT).  With the FGT: a fasting blood glucose level between 100-125 mg/dl can indicate pre-diabetes and > 126 mg/dl is diagnosed as having diabetes.

Develop over months and years of uncontrolled hyperglycemia and can affect the eyes, heart, kidneys, nervous system and circulatory system. 

• Increased risk of hypertension, heart attack, stroke, and circulatory complications

• Kidney/urinary failure

• Blindness and Diabetic Retinopathy; diabetes is responsible for 8% of legal blindness

• Diabetic Neuropathy/Nerve Damage/Peripheral Neuropathy

• Foot complications including sores/ulcers/injuries

• Skin complications and poor healing

• Chronic poor circulation and healing of sores or ulcers can lead to amputations of toes, foot or leg

Role of Exercise:

Exercise is an important treatment consideration for the management of Diabetes. Positive effects of exercise are numerous.  

• Lowers blood sugar levels (within 12-24 hours)

• Increases circulation

• Lowers cholesterol

• Decreases blood pressure

• Decreases risk for cardiovascular disease

• Reduces stress and depression

• Aerobic activity increases insulin sensitivity

Exercise Considerations:

Before starting any exercise program, you should consult your physician. A physical therapist is an excellent resource for exercise recommendations, especially if you are new to exercise and do not know where to begin.   With proper precautionary measures and monitoring, as well as an appropriate exercise program, many of the negative effects of Diabetes can be reduced significantly so you stay healthier! It is important to take into account the following when exercising with Diabetes:

• Monitor glucose levels before, during, and after exercise

• Have snacks available during and after exercise

• Aerobic activities are encouraged

• Patients with no complications may participate in strength training exercises

• Consume carbohydrates if glucose levels are <100 mg/dl

• Avoid isometric exercises (static contraction of a muscle) due to an increase in blood pressure

• Avoid exercise if glucose levels are >250 mg/dl with ketosis present

• Use caution if glucose levels are >300 mg/dl without ketosis present

• Avoid exercising muscles @ site of insulin injection for @ least 1 hr (to avoid too quick absorption of insulin)

• Wear proper footwear- especially those with peripheral neuropathy

• Wear medical alert bracelet

• Never exercise alone