Regardless of the type of diabetes, regular physical activity is important for your patients' overall health and wellness (ADA, 2023).
Physical Activity Recommendations: A = best evidence for improved outcome, B = good supportive evidence for improved outcome, C = some evidence/concensus or conflicting evidence for improved outcome
Exercise has been shown to improve blood glucose control, reduce cardiovascular risk factors, contribute to weight loss, and improve well-being.
Warning: routine physical activity is an important part of the diabetic care plan. Any change in physical activity will effect glycemic control. The attending physician and registered dietician must be notified of alterations in activity so that appropriate adjustment to diet and medication can be made to compensate for changed activity level. Changes in physical activity will also require increased vigilance and glucose testing until the effects of the new routine are known.
Special (diabetic) considerations for physical activity:
- Drink plenty of fluids while being physically active to prevent dehydration (harmful loss of water in the body).
- Make sure to check your blood sugar before being physically active, especially if you take insulin.
- If it’s below 100 mg/dL, you may need to eat a small snack containing 15-30 grams of carbohydrates, such as 2 tablespoons of raisins or ½ cup of fruit juice or regular soda (not diet), or glucose tablets so your blood sugar doesn’t fall too low while being physically active. Low blood sugar (hypoglycemia) can be very serious.
- If it’s above 240 mg/dL, your blood sugar may be too high (hyperglycemia) to be active safely. Test your urine for ketones – substances made when your body breaks down fat for energy. The presence of ketones indicates that your body doesn’t have enough insulin to control your blood sugar. If you are physically active when you have high ketone levels, you risk ketoacidosis – a serious diabetes complication that needs immediate treatment.
- When you’re physically active, wear cotton socks and athletic shoes that fit well and are comfortable.
- After your activity, check to see how it has affected your blood glucose level.
- After being physically active, check your feet for sores, blisters, irritation, cuts, or other injuries. Call your health care provider if an injury doesn’t begin to heal after 2 days.
Source: Get Active! https://www.cdc.gov/diabetes/managing/active.html
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While physical activity is recommended for nearly everyone, the benefits of exercise for people with diabetes are even greater than for non-diabetics. Aerobic exercise provides the safest and most benefits for people with diabetes to achieve blood glucose control and to improve cardiovascular status.
The current American Diabetes Association recommendations are:
Moderate to high levels of aerobic activity are associated with substantially lower cardiovascular and overall mortality risks in both type 1 and type 2 diabetes.
Aerobic exercise promotes cardio-pulmonary distribution of oxygen throughout the body. Aerobic exercise involves repetitive contraction of major muscle groups at a rate and intensity that does not result in rapid oxygen depletion. Optimum aerobic exercise occurs between 70-80% of maximun effort. Continuous moderate intensity swimming, cycling, walking or jogging are examples of aerobic exercise.
Anaerobic exercise
is high intensity, short duration exercise that exceeds the body's ability to supply oxygen. Anaerobic exercise results in oxygen deficit and lactic acid production. Anaerobic exercise occurs between 80-90% of maximum effort. Examples of anaerobic exercise include: resistance training, heavy weight-lifting, any type of sprint, isometrics, etc. Anaerobic
exercise does not confer the same health benefits as an aerobic program. In addition,
anaerobic exercise and certain types and intensity levels of aerobic exercise
may produce excessive rises in blood pressure, cardiac workload, and pressure
within the eye (intraocular pressure). These reactions can be potential problems
in persons with diabetes who have eye disease or cardiovascular disease.
Exercise was first recommended as a therapy for lowering blood glucose levels in the 20th century. Regular exercise is now a primary component of diabetes management. Much of the morbidity and mortality associated with diabetes are due to cardiovascular disease. Research studies have consistently demonstrated that regular exercise and physical fitness are associated with decreased cardiovascular disease in the population at large and a decrease in the incidence of type 2 diabetes.
Although regular exercise is beneficial for everyone, here are some specific benefits of exercise for people with diabetes:
In patients with type 1, it’s very important to balance insulin doses with food and activity blood sugar response to exercise will vary depending on:
Evidence supporting exercise
References
American Diabetes Association (2023). Standards of Care in Diabetes—2023 Abridged for Primary Care Providers. Clin Diabetes; 41. Accessed 8/18/2023 from https://diabetesjournals.org/clinical/article/41/1/4/148029/Standards-of-Care-in-Diabetes-2023-Abridged-for
Kanaley, J. A., Colberg, S. R., Corcoran, M. H., Malin, S. K., Rodriguez, N. R., Crespo, C. J., Kirwan, J. P., & Zierath, J. R. (2022). Exercise/Physical Activity in Individuals with Type 2 Diabetes: A Consensus Statement from the American College of Sports Medicine. Medicine and science in sports and exercise, 54(2), 353–368. https://doi.org/10.1249/MSS.0000000000002800
Richter E. A. (2021). Is GLUT4 translocation the answer to exercise-stimulated muscle glucose uptake?. American journal of physiology. Endocrinology and metabolism, 320(2), E240–E243. https://doi.org/10.1152/ajpendo.00503.2020
Soo, J., Raman, A., Lawler, N. G., Goods, P. S. R., Deldicque, L., Girard, O., & Fairchild, T. J. (2023). The role of exercise and hypoxia on glucose transport and regulation. European journal of applied physiology, 123(6), 1147–1165. https://doi.org/10.1007/s00421-023-05135-1
Verboven, M., Van Ryckeghem, L., Belkhouribchia, J., Dendale, P., Eijnde, B. O., Hansen, D., & Bito, V. (2019). Effect of Exercise Intervention on Cardiac Function in Type 2 Diabetes Mellitus: A Systematic Review. Sports medicine (Auckland, N.Z.), 49(2), 255–268. https://doi.org/10.1007/s40279-018-1003-4