By Mary Ann Wilson, RN
Diabetes is a serious disorder that affects approximately 17 million people in the US. It is the 5th deadliest disease in the country, contributing to over 200,000 deaths each year. It has no cure. Diabetes stems from either a failure to produce or to properly use the hormone insulin. Insulin enables glucose, the basic sugar derived from carbohydrate foods, to move from the blood into the muscle cells. The muscle cells use glucose for energy. When glucose (sugar) cannot enter the muscle cells, blood sugar levels increase. It is these increased blood sugar levels that cause the severe complications of diabetes.
There are two separate and distinct diabetes diseases: insulin dependent diabetes mellitus—IDDM, and non-insulin dependent diabetes mellitus—NIDDM. See the table below for a comparison of the two types.
INSULIN DEPENDENT DIABETES MELLITUS (IDDM) NON-INSULIN DEPENDENT
Known as Type I or juvenile onset diabetes Known as Type II or adult onset diabetes
10-15% of diabetes cases 85-90% of diabetes cases
Sudden onset, usually beginning in childhood Gradual onset, usually diagnosed after age 45
Specialized beta cells in the pancreas fail to produce insulin.
Body appears to attack its own beta cells. Disease is due either to
• sensitivity of muscle cells to insulin, or
• defective insulin secretion from pancreas.
Heredity & obesity are important factors in its development.
Treatment aim: normalize blood sugar levels, Treatment aim: normalize blood sugar levels.
Insulin by injection is required to control blood sugar levels. Careful monitoring and proper dosing of insulin is essential. Diet, exercise, and weight control may adequately control blood sugar levels. If drugs are required, oral medications that enhance the release of insulin from the pancreas or increase sensitivity of muscle cells to insulin are generally used. Sometimes insulin may be necessary to achieve adequate blood sugar control.
Exercise aimed at improving health of the heart and circulatory system and decreasing disease complications. Blood sugar levels should be fairly well controlled for aerobic exercise to be safe. Exercise aimed at controlling blood sugar levels by reducing body weight and helping to decrease medication requirements. This is best accomplished by exercising daily with a low to moderate intensity and long duration. Improved cardiovascular health and reduction of disease complications are added benefits of exercise.
Elevated blood sugar levels damage the blood vessels throughout the body and are responsible for the severe complications associated with diabetes. It is estimated that 60-70% of diabetics develop one or more complications. Major complications include:
• Heart disease
• High blood pressure
• Kidney disease
• Poor circulation which hinders healing and may necessitate amputation
• Blindness due to damage to the small vessels in the back of the eye
• Nerve damage, especially to the nerves in the feet, hands, and legs
The interactions between exercise, carbohydrate intake, blood sugar levels, and insulin regulation are complex. Therefore, if you have diabetes, it is important to work closely with your medical team (physician, diabetic educator, dietician, exercise specialist) to establish a treatment plan that accounts for your specific medication, exercise, and dietary needs. A team approach will help you learn more about your disease and determine what you need to do personally to minimize its complications.
Exercise and Diabetes
Regardless of the type of diabetes one has, it has been shown that exercise improves:
• general quality of life
• glucose control
• insulin sensitivity
• metabolic control
• and reduces risk factors and complications of diabetes and may prevent NIDDM
It is estimated that 60-70% of diabetics develop one or more complications. Exercise helps manage complications, can reverse complications, or slows down development of complications.
Because an exercise program influences diabetes control, any exercise program must be closely supervised by a health professional. Before beginning any exercise program, check with your doctor first! Diabetics have several special concerns; your doctor will advise you on the benefits and hazards of exercise.
It is best to have some form of exercise on a daily schedule, not only for overall good health, but to help keep glucose levels constant and improve circulation. A cautionary note: any exercise, even simple ones, can influence these glucose levels, so consult with your physician to establish guidelines on how often and how vigorous your workout should be.
If the person who has diabetes is able-bodied, walking and swimming are often recommended activities. For someone who is more sedentary, a less rigorous program is prescribed. Also, try eating a light carbohydrate snack (i.e., a piece of whole wheat toast) and a glass of milk thirty minutes before exercising.
Getting Started and Guidelines
• Start with medical exam
• Discuss symptoms, complications, etc. with doctor
• Exercise in A.M. or early afternoon (to prevent delayed hypoglycemia during sleep)
• Make it a habit and exercise regularly.
• Exercise after snack and before injection OR 60 to 90 minutes after injection
• Don’t exercise when insulin is peaking
• Monitor blood glucose levels
prior to exercise
• Have adequate fluid intake before, during and after exercise, since there is predisposition to dehydration—
• Consume 15 to 30 grams carbohydrate for every 30 minute of exercise
• Consume slowly absorbed carbohydrate snack following exercise
• Keep a journal or log of exercise session,
how you felt (invigorated, fatigued, light-headed, etc.)
• Inspect feet before and after exercise
• Proper footwear.
Chair exercises can be an important part of the diabetic person’s total exercise program. Chair exercise goals include:
• improve posture • teach deep breathing
• increase joint flexibility and range of motion • increase muscle strength
• increase circulation • stress reduction and relaxation
• improve balance
Each individual will need to work out modifications unique to them with their doctor:
In general, exercise modifications for those with diabetes include:
• Avoid exercises that involve heavy resistance or holding the breath because of the potential vascular effects.
• Use rate of perceived exertion (RPE) to determine exercise intensity.
• Avoid high intensity activity. Avoid extreme environments.
• Protect the feet with supportive, well-fitting shoes and socks.
There are two medical emergencies that can potentially arise for diabetic persons during or following exercise exertion: hypoglycemia and hyperglycemia.
1. Hypoglycemia–excessive lowering of blood sugar levels–may arise because of too much insulin, not eating enough or on time, or exercising strenuously without eating. Symptoms one must be alert to include headache, dizziness, confusion, fatigue, nausea, and sweating. At the first sign of hypoglycemia, the diabetic person should eat some form of sugar (candy, a sugar cube, or juice), otherwise symptoms may progress, leading to coma or even permanent brain injury. People with diabetes should always be prepared by carrying candy with them in the event hypoglycemia occurs. The caregiver should also have a plan in place should the client experience hypoglycemia and not be prepared themselves.
2. Hyperglycemia–excessive elevation of blood sugar levels–can be caused by taking too little insulin, eating more than planned, exercising less than planned, or an additional stress to the body such as an illness. Frequent urination and excessive thirst are early signs of hyperglycemia. Immediate emergency medical treatment of hyperglycemia is important, or more serious symptoms will develop. Fluids may be given if the patient is conscious while waiting for emergency medical assistance. Sugar should not be given.* Several hours of fluid and insulin therapy under physician supervision will be required. With inadequate insulin, the body cannot use glucose for energy, so it begins to break down fats for fuel. This produces waste products called ketones. The body cannot tolerate ketones and attempts to release them through the urine, but it can’t get rid of all of them, so they build up in the blood, causing ketoacidosis, which is a life-threatening medical emergency. The symptoms of ketoacidosis are shortness of breath, fruity-smelling breath, nausea, vomiting, and a very dry mouth.