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Diabetes - exercise, diet & medications.

Diabetes mellitus affects approximately 20 million people in the United States. It is the third leading cause of death and is responsible for approximately five percent of all hospital admissions. Despite an enormous amount of research, the incidence of diabetes is increasing by about six percent per year and there is still no clear understanding as to its cause, nor is there a cure.

Diabetes mellitus is a metabolic disease caused by bodily malfunctions in utilizing glucose. Glucose, or blood sugar, is the fuel the body needs for energy. Insulin, which is secreted by the pancreas, helps make cell walls permeable. This promotes the entry of glucose molecules into the cells where it can be used for energy.

There are two classifications of diabetes. Type I (juvenile onset) is referred to as insulin dependent diabetes mellitus (IDDM) and usually develops before age 351 Type II (adult onset) is referred to as non-insulin dependent diabetes mellitus (NIDDM) and usually affects people over age 40. IDDM diabetics suffer from a malfunction of their pancreas to produce insulin. NIDDM diabetics usually produce insulin from the pancreas, but the secretion levels may be too low and/or there may be a lack of sensitivity in the insulin receptor cells. This leads to elevated blood glucose levels (hyperglycemia). Symptoms of hyperglycemia include increased urination, thirst and unusual fatigue. Either type of diabetes is a chronic systemic disorder and can be fatal if left untreated.

Maintaining a normal blood sugar level is critical for persons with diabetes. Normal blood glucose levels are 70-150 mg/dL. Hyperglycemia occurs when the glucose level exceeds 150 mg/dL and hypoglycemia (low blood sugar) occurs when glucose levels are less than 60 mg/dL.

Studies demonstrate persons with diabetes can live long, productive lives with reduced risk of secondary problems if the disease is managed carefully. This involves insulin injections (for those requiring insulin) or oral hypoglycemic agents, dietary education, proper exercise programs and self-monitoring. People who monitor their diabetes have shown profound reductions in secondary complications of the disorder.

Individuals with diabetes are two to three times more likely to experience high blood pressure. Because a rise in blood pressure may occur during exercise, it is important to monitor blood pressure and select an appropriate exercise activity and intensity level.

Controlling Diabetes:


Persons with diabetes should eat a high carbohydrate, low fiber, low fat, moderate protein, low sugar, low sodium meal three hours prior to intense exercise or competition.


Regular exercise is the most overlooked and crucial treatment for controlling diabetes. Exercise improves blood glucose control, reduces cardiovascular risk and improves circulation. Each person should engage in a form of exercise recommended by his or her physician. The intensity and duration of exercise will determine the levels of blood glucose and insulin usage within the body. Walking briskly for 20 minutes three times per week can reduce the risk of type II diabetes. Your physician can advise you on medication needed and adequate dietary requirements to assure your safety during exercise.

Aerobic exercise should be performed at 55 to 85% of your maximum heart rate three to five times per week for a minimum of 20 minutes. Check with your doctor for your specific heart rate intensity and duration.

Strength training should start at 40-60% of one maximum repetition (1 RM), gradually building to 80% of 1 RM. Perform a minimum of one set of eight to 12 repetitions two times per week. Make sure that all major muscle groups are worked. Perform approximately eight to 10 exercises for a total body workout. Check with your doctor for any contraindications regarding resistance training.


For insulin dependent diabetics, there are many factors which influence the body's insulin utilization. Exercise may cause hypoglycemia or hyperglycemia due to an increase in metabolic demands. The following are preventive tips for persons with diabetes who exercise.

* Avoid injecting insulin into a part of the body which will be exerted during exercise. This may increase or shorten duration of insulin reaction.

* Avoid exercising at the peak of insulin activity. Injection of insulin should be administered one hour prior to the start of exercise.

* Avoid alcohol and beta blocker drugs around the time of exercise because they promote hypoglycemia.

* Eat a snack just before and during exercise.

* Keep simple carbohydrates, such as fruit juice or hard candy, and other food available. If you are a competitor, ask the team physician to carry extra insulin for emergencies.

* Always carry emergency cash and identification listing your medical condition and medications used.

* If you experience pain in your chest, nausea, heart palpitations or severe shortness of breath during exercise, stop and consult your doctor.

* Test blood glucose before, during or after exercise.

* Watch for post-exercise hypoglycemia up to 15 hours after activity.

* If blood glucose levels are above 240-300 mg/dL, or below 60 mg/dL, don't exercise.

Foot Care

Since diabetes is the major cause of nontraumatic amputation, proper foot care is important. Exercising leads to sweaty feet and can precipitate foot problems. Follow these tips to prevent foot infections.

* Wash your feet daily.

* Use foot creams or lubricating oils.

* Have a podiatrist show you how to cut toenails correctly.

* Never cut calluses or corns.

* Never walk barefoot.

* Wear appropriate shoes and inspect their insides daily.

* Seek medical care for all skin lesions.

* Avoid smoking and use of all tobacco products.


Prevent dehydration by drinking two cups of water two hours before exercise. Drink one to two cups 30 minutes before exercise, one-half cup every 15 minutes during exercise and enough afterward to regain any water lost to perspiration while exercising.

Behavioral Changes

Anxiety, depression and denial are extremely common in diabetics. They are often given prescription medications to combat these psychological problems. These medications frequently have side effects that can influence the diabetic's capacity for a proper exercise routine. Recognizing the differences between side effects which do or do not affect a person's exercise participation is crucial to the value of the exercise itself.

Note: This information educational purposes only. As such, it is not a substitute for medical advice. Consult your doctor for medical advice.


Many factors may contribute to the development of diabetes, including:

* Obesity--80% of diabetics are overweight.

* Heredity

* Age--Frequency of incidence increases in people over age 40.

* Diet


* Physical inactivity
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Title Annotation:continuing education article; includes test
Publication:American Fitness
Date:Sep 1, 1998
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