Exercise has long been considered an important element in diabetes treatment, especially with a type 2 diabetic because of its positive influence on insulin resistance.
Appropriate footwear is important, due to the risk of peripheral neuropathy, and ulcers. Those who are exercising alone should be aware of the importance of self-examination and advised how to conduct this by their healthcare or medical professional.
Before exercise participation blood glucose levels should be measured to determine the stability of blood glucose levels, and their stability suitability to participate. In cases where hypoglycaemia is a risk, 15 to 30 grams of carbohydrate should be consumed to help stabilize blood glucose concentrations. It is also extremely important to monitor blood glucose post-exercise because patients are far more likely to experience hypoglycaemia during this period, due to the replenishment of muscle glycogen.
A carbohydrate drink or meal within 60 minutes of the exercise session is strongly recommended.
It is also important that one does not exercise too close before bedtime, especially when living alone. If one were to experience post-exercise hypoglycaemia while sleeping, the likelihood of detection, unless somebody tried to wake them would be slim. In these circumstances, the patient could slip into a diabetic coma.
There are many psychological benefits associated with regular participation in exercise. These benefits are equally applicable to a diabetic patient because the burden of diabetes can have a detrimental effect on psychological well being.
The frequency, intensity and mode of exercise appropriate to the patient will largely depend on individual capabilities and requirements.
Patients with type 2 diabetes should seek exercise every second or third day to maintain improvements in glycemic control.
Type 1 diabetics are likely to need to adjust their insulin usage around exercise and physical activity. It may be more appropriate to exercise daily and maintain a structured routine whereby insulin is taken at the same time each day. This will help to improve the management of the condition.
To avoid hypoglycaemia one should inject insulin in the sites, away from the muscles, they will be using most during exercise. Additionally, insulin injection sites should be rotated regularly, whether exercising or not.
Diabetics that significantly increase their level of lean mass are unlikely to observe a reduction in their exogenous insulin requirements. Because muscle tissue is insulin dependent such patients will require more insulin to supply the new tissues with glucose.
A patient should not exercise if:
- If they have an active retinal haemorrhage
- Illness or infection is present
- Blood glucose levels exceeding 13.8 with unary ketones
- Blood glucose levels lower than 4.4. due to the risk of hypoglycaemia
The following caution should be taken:
- Have a source of carbohydrate available during the exercise session that does not contain fat.
- Consume fluids before during and after exercise.
- Practice good foot care by wearing proper training shoes and cotton socks (a thorough examination should also be conducted).
- Ensure medical identification with details of the condition is carried.
- Ensure any other medications being prescribed are at hand.
- Ensure all medications have been taken as part of the management or treatment plan for the day.