Diabetes Diet

Description

Alternative Names

Exercise

Sedentary habits, especially TV watching, are associated with significantly higher risks for obesity and type 2- diabetes. Regular exercise, even of moderate intensity (such as brisk walking), improves insulin sensitivity and may play a significant role in preventing type 2 diabetes--regardless of weight loss. An important study reported a 58% lower risk for type 2 diabetes in adults who performed moderate exercise for as little as 2.5 hours a week.

In 2002, a well-conducted study on overweight adults confirmed previous research that reported beneficial changes in cholesterol and lipid levels, including lower LDL levels (the so-called bad cholesterol), even when people performed low amounts of moderate or high intensity exercise (e.g., walking or jogging 12 miles a week). However, more intense exercise is required to significantly change cholesterol levels, notably increasing HDL (the so-called good cholesterol). An example of such a program would be jogging about 20 miles a week. Such benefits in the study occurred even with very modest weight loss, suggesting that overweight people who have trouble losing pounds can still achieve considerable heart benefits by exercising.

Aerobic Exercises. Aerobic exercise is proving to have significant and particular benefits for people with both type 1 and type 2 diabetes. Regular aerobic exercise, even of moderate intensity, improves insulin sensitivity. People with diabetes are at particular risk for heart disease, so the heart protective effects of aerobic exercise are very important for this patient population. Moderate exercise, in fact, protects the heart in people with type 2 diabetes, even if they have no risk factors for heart disease other than diabetes itself. (In general, when exercising people with diabetes, should aim for a heart rate target of 55% to 75% of their maximum heart rate.)

Strength Training. Strength training, which increases muscle and reduces fat, may be particularly helpful for people with diabetes, but evidence is needed to confirm this.

Yoga. One study reported that yoga helped patients with type 2 diabetes reduce their need for oral medications.Studies have indicated that yoga and Tai Chi (an ancient Chinese exercise involving slow relaxing movements) may lower blood pressure almost as well as moderate-intensity aerobic exercises.

Some Precautions for People with Diabetes Who Exercise. The following are precautions for all people with diabetes, whether type 1 or 2:

• Because people with diabetes are at higher than average risk for heart disease, they should always check with their physicians before undertaking vigorous exercise. For best and fastest results, frequent high-intensity (not high-impact) exercises are best for people who are cleared by their physicians. For people who have been sedentary or have other medical problems, lower-intensity exercises are recommended using regimens designed with physicians.
• Strenuous strength training or high-impact exercise is not recommended for people with uncontrolled diabetes. Such exercises can strain weakened blood vessels in the eyes of patients with retinopathy. High-impact exercise may also injure blood vessels in the feet.

Patients who are taking medications that lower blood glucose, particularly insulin, should take special precautions before embarking on a workout program.

• Glucose levels swing dramatically during exercise; people with diabetes should monitor their levels carefully before, during, and after workouts.
• Patients should probably avoid exercise if glucose levels are above 300 mg/dl or under 100 mg/dl.
• To avoid hypoglycemia, diabetics should inject insulin in sites away from the muscles they use the most during exercise.
• They should also drink plenty of fluids. Before exercising, they should also avoid alcohol, which increases the risk of hypoglycemia.
• Insulin-dependent athletes may need to decrease insulin doses or take in more carbohydrates prior to exercise but may need to take an extra dose of insulin after exercise. Stress hormones released during exercise may increase blood glucose levels; in non-diabetics insulin is released to control this. The diabetic, therefore, needs to test their blood sugar and take an extra dose as instructed by their diabetes healthcare provider.
• Anyone with existing hypertension should discuss an exercise program with their physician. Before starting to exercise, people with moderate to severe hypertension should lower their pressure and be able to control it with medications. They should avoid caffeinated beverages, which increase heart rate, the workload of the heart, and blood pressure during physical activity. Everyone, and especially people with high blood pressure, should breath as normally as possible through each exercise. Holding the breath increases blood pressure.
• Good, protective footwear is essential to help avoid injuries and wounds in the feet.

[For more detailed information,see Well-Connected Report #29 Exercise.]

Stress Reduction

Chronic stress has been associated with the development of insulin-resistance, a condition in which the body is unable to use insulin effectively to regulate glucose (blood sugar). Insulin-resistance is a primary factor in diabetes. Stress can also exacerbate existing diabetes by impairing the patient's ability to manage the disease effectively.

[For recommendations on stress reduction, seeWell-Connected Report #31 Stress.]