Preventing Lows Your blood glucose response to exercise will vary depending on: Sometimes people experience a drop in blood glucose during or after exercise, so it is very important to monitor your blood glucose, take proper precautions, and be prepared to treat hypoglycemia low blood glucose.
PN, peripheral neuropathy During physical activity, whole-body oxygen consumption may increase by as much as fold, and even greater increases may occur in the working muscles.
To meet its energy needs under these circumstances, skeletal muscle uses, at a greatly increased rate, its own stores of glycogen and triglycerides, as well as free fatty acids FFAs derived from the breakdown of adipose tissue triglycerides and glucose released from the liver.
To preserve central nervous system function, blood glucose levels are remarkably well maintained during physical activity.
Hypoglycemia during physical activity rarely occurs in nondiabetic individuals. The metabolic adjustments that preserve normoglycemia during physical activity are in large part hormonally mediated. A decrease in plasma insulin and the presence of glucagon appear to be necessary for the early increase in hepatic glucose production during physical activity, and during prolonged exercise, increases in plasma glucagon and catecholamines appear to play a key role.
These hormonal adaptations are essentially lost in insulin-deficient patients with type 1 diabetes. As a consequence, when such individuals have too little insulin in their circulation due to inadequate therapy, an excessive release of counterinsulin hormones during physical activity may increase already high levels of glucose and ketone bodies and can even precipitate diabetic ketoacidosis.
Conversely, the presence of high levels of insulin, due to exogenous insulin administration, can attenuate or even prevent the increased mobilization of glucose and other substrates induced by physical activity, and hypoglycemia may ensue. Similar concerns exist in patients with type 2 diabetes on insulin or sulfonylurea therapy; however, in general, hypoglycemia during physical activity tends to be less of a problem in this population.
Indeed, in patients with type 2 diabetes, physical activity may improve insulin sensitivity and assist in diminishing elevated blood glucose levels into the normal range.
The purpose of this position statement is to update and crystallize current thinking on the role of physical activity in patients with types 1 and 2 diabetes.
With the publication of new clinical reviews, it is becoming increasingly clear that physical activity may be a therapeutic tool in a variety of patients with, or at risk for diabetes, but that like any therapy its effects must be thoroughly understood 1—3.
From a practical point of view, this means that the diabetes health care team will be required to understand how to analyze the risks and benefits of physical activity in a given patient. Furthermore, the team, consisting of but not limited to the physician, nurse, dietitian, mental health professional, and patient, will benefit from working with an individual with knowledge and training in exercise physiology.
Finally, it has also become clear that it will be the role of this team to educate primary care physicians and others involved in the care of a given patient. This examination should carefully screen for the presence of macro- and microvascular complications that may be worsened by the exercise program.
Identification of areas of concern will allow the design of an individualized exercise prescription that can minimize risk to the patient. A careful medical history and physical examination should focus on the symptoms and signs of disease affecting the heart and blood vessels, eyes, kidneys, feet, and nervous system.
Cardiovascular system A graded exercise test may be helpful if a patient, about to embark on a moderate- to high-intensity physical activity program Table 1 4 — 6is at high risk for underlying cardiovascular disease, based on one of the following criteria: Patients with known coronary artery disease should undergo a supervised evaluation of the ischemic response to exercise, ischemic threshold, and the propensity to arrhythmia during exercise.
In many cases, left ventricular systolic function at rest and during its response to exercise should be assessed. Peripheral arterial disease Evaluation of peripheral arterial disease PAD is based on signs and symptoms, including intermittent claudication, cold feet, decreased or absent pulses, atrophy of subcutaneous tissues, and hair loss.
The basic treatment for intermittent claudication is nonsmoking and a supervised physical activity program. The presence of a dorsalis pedis and posterior tibial pulse does not rule out ischemic changes in the forefoot. If there is any question about blood flow to the forefoot and toes on physical examination, toe pressures as well as Doppler pressures at the ankle should be carried out.
For patients who have proliferative diabetic retinopathy PDR that is active, strenuous activity may precipitate vitreous hemorrhage or traction retinal detachment.
These individuals should avoid anaerobic exercise and physical activity that involves straining, jarring, or Valsalva-like maneuvers. On the basis of the Joslin Clinic experience, the degree of diabetic retinopathy has been used to stratify the risk of physical activity and to individually tailor the physical activity prescription.
Patients with overt nephropathy often have a reduced capacity for physical activity, which leads to self-limitation in activity level. Although there is no clear reason to limit low- to moderate-intensity forms of activity, high-intensity or strenuous physical activity should probably be discouraged in these individuals unless blood pressure is carefully monitored during exercise.
Significant PN is an indication to limit weight-bearing exercise.
Repetitive exercise on insensitive feet can ultimately lead to ulceration and fractures. Evaluation of PN can be made by checking the deep tendon reflexes, vibratory sense, and position sense. Touch sensation can best be evaluated by using monofilaments.
The inability to detect sensation using the 5. Table 3 lists contraindicated and recommended physical activity for patients with loss of protective sensation in the feet. Sudden death and silent myocardial ischemia have been attributed to CAN in diabetes.
Resting or stress thallium myocardial scintigraphy is an appropriate noninvasive test for the presence and extent of macrovascular coronary artery disease in these individuals.
Hypotension and hypertension after vigorous physical activity are more likely to develop in patients with autonomic neuropathy, particularly when starting a physical activity program. Because these individuals may have difficulty with thermoregulation, they should be advised to avoid physical activity in hot or cold environments and to be vigilant about adequate hydration.
The young individual in good metabolic control can safely participate in most activities. The middle-aged and older individual with diabetes should be encouraged to be physically active. The aging process leads to a degeneration of muscles, ligaments, bones, and joints, and disuse and diabetes may exacerbate the problem.
Before beginning any physical activity program, the individual with diabetes should be screened thoroughly for any underlying complications as described above.Physical activity is very important for people with diabetes!
|Don't Miss Out! Get the FREE EndocrineWeb eNewsletter!||Eat foods with heart-healthy fats, which mainly come from these foods:|
Good news – it’s not as hard as you might think to be more active. The goal is to get at least minutes per week of moderate-intensity physical activity. One way to do this is to try to fit in at least 20 to 25 minutes of activity.
Physical Activity Guidelines for Diabetes and Prediabetes. A Web-based Training. Presented by. Ralph LaForge, MSc, Exercise Physiologist. Division of Endocrinology, Duke University. Regular physical activity is one of the most important things you can do to manage and live well with diabetes.
Regular exercise has special advantages if you have type 2 diabetes. It can improve your body’s sensitivity to . You can read more about the benefits of physical activity for people with type 1 diabetes in our article about exercise and type 1 diabetes. Activities for Your Child with Type 1 Diabetes Being active is most beneficial when it's done on a regular basis.
Jun 25, · The American College of Sports Medicine and the American Diabetes Association have recommended at least min/wk of moderate (50%% of an individual’s maximum heart rate) to vigorous (> 70% of an individual’s maximum heart rate) physical activity for patients with type 2 diabetes .
“Physical activity is an essential part of managing Type 1 diabetes and protecting against the serious complications of the condition such as heart disease, stroke, kidney failure, blindness and amputation.