Diabetes and Exercise - Decide to Move
Exercising With Diabetes Complications: How to Get Moving
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Exercise is an essential part of managing type 2 diabetes. It can help you control your blood sugar, manage your weight, and improve your overall health. Diabetes complications like neuropathy or retinopathy can make getting regular physical activity more difficult, but they shouldn’t stop you from exercising altogether.
If you have type 2 diabetes, your body either doesn’t produce enough insulin or can’t properly use the insulin it does produce to move sugar from the blood into the cells that need it for energy. As a result, blood sugar levels can rise higher than normal. High blood sugar levels affect just about every part of the body, which is why type 2 diabetes can cause complications from head to toe.
“Very rarely do I see someone with type 2 diabetes who doesn’t have some other complication,” says Jim Dunleavy, PT, a doctor of physical therapy and the director of rehabilitation services at Trinitas Regional Medical Center, in Elizabeth, New Jersey.
Staying active when you have complications is beneficial, but it can be challenging. People with type 2 diabetes can feel tired and experience pain in their joints and pain and numbness in their feet. For some, even walking can be difficult or painful. But taking steps toward getting active is worth it.
“Exercise creates more receptors on cells where insulin can go to work, allowing blood glucose to get into cells,” says Karen Kemmis, PT, a fellow of the American Society of Diabetes Educators who works at the Joslin Diabetes Center at SUNY Upstate University Hospital, in Syracuse, New York. “Exercise helps the muscles to use glucose more easily.”
And, says Kemmis, exercise can keep cholesterol in check and help ward off depression and anxiety, to which people with diabetes may be prone.
To begin an exercise program, Kemmis recommends that you start slowly and increase your workout gradually. For those who have been sedentary, she recommends starting the first week with 10 minutes of exercise twice a day for at least four days. The next week, she advises adding a 5-minute session to your day. By gradually increasing your workout in this way, you should work toward a regimen of 30 minutes a day most days of the week. Always talk to your doctor before beginning a new workout routine, especially if you have complications.
Here, Kemmis shares the best exercises for some of the most common diabetes complications, as well as workouts to avoid and safety tips to keep in mind:
Diabetes can damage the nerves in your feet so that you may not be able to feel a sore or cut. Such injuries can lead to serious infections that could ultimately necessitate amputation. And because the damage from diabetes reduces blood flow and oxygen flow to the feet, it can be harder for feet to heal. About 60-70 percent of people with diabetes have foot ailments.
Smart exercises:Any weight training that doesn't cause your feet to press against equipment is beneficial. You can include biceps curls, lateral pull-downs, and rows, for example. Core-strengthening exercises, such as crunches and yoga, can also be beneficial. For those with no wounds, other effective exercises include swimming, water aerobics, and bicycling.
Exercises to avoid:Avoid leg presses and any exercises in which your weight is always on your feet. Also avoid running and strenuous hiking.
Safety tips:Every day, check your feet for injuries, making sure you inspect the soles of your feet and in between your toes. Work with a podiatrist to get shoes and inserts specifically fit for your exercise needs. Find socks made of breathable material that have minimal or no seams.
Heart Disease and Kidney Disease
Over time, high levels of sugar in the blood can leave fatty deposits on blood vessel walls. Such deposits can increase the risk of heart disease and lead to atherosclerosis, or hardening of the arteries. People with diabetes are twice as likely to have heart disease as those who don't have the condition. High blood sugar can also damage kidneys, hampering their ability to remove waste and fluids from the blood. The leading cause of kidney failure in the United States is diabetes.
Smart exercises:Light aerobic exercise is a good option, as is walking or stationary cycling, as long as you keep your pace at a moderate intensity. Combine endurance aerobic exercise with some weight training to build strength.
Exercises to avoid:Avoid strenuous weight training, as well as any weight exercise at which you can’t comfortably complete 12 repetitions. Upper body and arm exercises can increase pressure on the heart, so you're better off choosing exercises that specifically target your legs.
Safety tips:Check with your doctor before you begin any exercise that’s beyond your normal, daily activities — this is especially crucial for people who have heart or kidney disease. When working out, don’t overexert yourself. You should be able to carry on a conversation without being short of breath. A heart rate monitor and an oximeter, which measures the oxygen in the blood, can help you keep track of your level of exertion.
Diabetes can reduce the amount of oxygen carried to blood vessels, which may cause nerve signals to slow, to halt, or to fire at the wrong times. More than half of the people who have diabetes have some form of this abnormal nerve behavior, or neuropathy, which can cause symptoms such as numbness in the extremities, shooting pains, and dizziness. In addition to peripheral neuropathy, which affects hands and feet, people with diabetes may also experience autonomic neuropathy, which affects the nerves to the heart and other organs.
Smart exercises:Walking on solid, even surfaces can be beneficial, as long as you can tolerate the movement. Other good exercises include stationary cycling, water exercises such as swimming and water aerobics, strength training on gym machines, and elliptical workouts.
Exercises to avoid:Walking or running on uneven trails while hiking. Also, skip any high-intensity, strenuous exercises, such as fast-paced aerobics.
Safety tips:After exercise, do a visual check of body parts that experience neuropathy. Use a small mirror to check your extremities, looking between your toes and at the bottoms of your feet. Also, keep lotion handy to make sure your skin doesn’t get dry after exercise. If you experience autonomic neuropathy, avoid exercising in hot locations, closely monitor your heart rate, and rest if you feel light-headed or short of breath.
This complication is the most common cause of vision loss among people who have diabetes. It occurs when blood vessels in the retina hemorrhage, which impairs vision. Retinopathy can worsen and lead to scarring and loss of retina cells.
Smart exercises:Any exercises that don’t entail excessive straining can be good for those with retinopathy. Such exercises include light aerobics, walking, stationary biking, and water aerobics.
Exercises to avoid:Any workout that involves heavy weights or excessive straining should be avoided. Any jarring of the head or positioning of the head below the waist should be avoided — this includes diving and running. Also, avoid such exercise as cycling, which requires peripheral vision.
Safety tips:For gym machine workouts, you should be able to do 12 to 20 repetitions — that is, don’t set the weight so high that you can only do one or two repetitions. Exercise in a well-lit place that has an even surface.
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