Living with diabetes 3 - Diabetes and fitness

When suffering from diabetes it's important to move your body. In fact, along with a proper diet and medication, exercise will help you lower blood sugar levels, lose that extra weight you're eventually carrying and increases the glucose uptake by the cells.

However, I know the prospect of starting a regular workout regime might feel intimidating. And it's possible that you haven't exercised for years or ever.

But don't worry. I have some tips and tricks for you to start slowly.

Fitness and type 1 diabetes

Regular workouts will help to control blood glucose levels and improve HbA1c (glycated haemoglobin, which develops when haemoglobin joins with glucose in the blood). Furthermore, you will see improvements in insulin sensitivity and glucose metabolism.

You might have to increase your carbohydrate intake before the workout to avoid exercise-induced hypoglycaemia. Eating more carbs isn't necessarily a bad thing. Even when you're diabetic, carbs are not evil!

Many people who suffer from type 1 diabetes, have to use an insulin pump, which is needed to deliver a calculated dose of insulin at certain intervals.

With physician approval, you can safely disconnect the pump for 1–2 hours. Make sure to inspect your pump insertion sites before and right after exercise.

Activities that require special accommodations for an insulin pump

If swimming is your exercise of choice, you might have to disconnect the pump before you're going to the water, since the most pumps aren't waterproof.

If you plan to be disconnected, it's important to make sure you're replacing at least one portion of your missed basal insulin. Disconnecting shouldn't be a problem at all, just do a bolus correction or increase basal when you're finished with your workout session.

Diabetes and physical activity

There are three main categories of exercises. You should aim to have a good balance of all of them: cardio, strength training and flexibility.

Being more active will not only improve your insulin response, but it will also improve the way your body uses blood sugar. Furthermore it helps with weight loss and lowers the risk for heart diseases. And it also lifts your mood!

Before you start an exercise

It's crucial to keep your blood sugar levels in check before and after every workout, because if they're too high or too low it might not be safe to work out!

If your blood sugar level is below 100md/dL (5.6 mmol/L) you need to eat some carbs before you begin your workout (30 minutes prior your workout). You have to skip/postpone the workout, if your blood sugar level is higher than 250mg/dL (13.9mmol/L), with ketones in your urine.

Having a high amount of urinary ketones means that your insulin levels are too low and your body is breaking down fat for fuel. Don't exercise until you’ve got your glucose levels up to normal and your ketones down to just traces.

Please, don't do any resistance training, if your blood sugar levels are higher than 300mg/dL.

Make sure to always have some form of fast-acting carbs with you while you workout, such as glucose tablets, juice or a banana, to prevent exercise-induced hyperglycaemia and quickly boost your sugar levels if necessary.

Check your meds

Ask your GP, if the medication you're taking might affect you during exercise and if so, how.

There are some medications, that make your blood sugar levels drop too low. This might cause dizziness, fainting or seizures.

If you're on insulin medication, ask your doc if you need to adjust dosages on days where you workout.

Set realistic goals

Before you start with your workout routine, you need to set realistic goals. If you haven't really worked out before, you aren't going to jump into running a 5k or squat your own bodyweight right away. You need to build strength and stamina, both of which take time.

Give yourself the time your body needs, to adapt to a steady workout routine and slowly increase your activity level. Consistency is more important than one killer workout!

Increase your everyday activity

Getting back to working out after a pretty long time off? Then it's wiser to start slow. Aim for 30 minutes per workout session to begin with. Make sure to warm up and cool down properly for 5 minutes by doing some stretching.

A nice way to start getting more active is to take the stairs instead of the lift at the office or to do regular morning walks for 30 minutes at a brisk pace.

Nearly everything you do to move your body is better than inactivity. Consider parking as far away from your work as possible, so you have to walk more.

Workout 5 times a week

Aim for exercise 5 times a week. Have strength training and cardio at least twice a week. This is appropriate to see beneficial results from the respective type of exercise.

It's also better to workout more often, but to do lighter workouts, than go all in and heavy right away. Stimulating every muscle twice per week leads to better progress in the long run.

Prioritise strength training (weight lifting)

Strength training is a very effective way to control blood glucose, increase strength and improve the quality of life in individuals with diabetes. You really should give it a try!

Building muscle mass will help you to control your weight and diabetes: More muscles means a higher basal metabolic rate, which means better weight control and a much better insulin sensitivity (meaning, you need less insulin).

Implementing a good weight lifting routine, with a proper form, can help with losing body fat and controlling blood sugar levels.

2-3 sets per exercise is a good starting point. In general use lower reps/higher resistance for strength and higher reps/lower resistance for endurance.

Resting time between each set should be 60-90 seconds or 120 seconds for very hard compound exercises (squat, deadlift, bench press).

Forget about “No pain, no gain”

If suddenly something hurts, it feels too hard to do a particular exercise, you feel dizziness, shortness of breath or disorientation: stop immediately! Slow and steady wins the race, when it comes to fitness and better health for diabetics.

In fact, especially for starters it's better to work out every day with lighter workloads, because lighter weights will not increase blood pressure as much as higher loads do.

Pay more attention to your feet

People with diabetes are at much greater risk of developing problems with their feet. The reason behind that, is the damage raised blood sugar levels can cause to sensation and circulation.

Left untreated, these problems can cause infections and - worst case - might lead to amputation.

Therefore, make sure to wear very comfortable and safe footwear. Never run in inappropriate shoes, because your feet need special support.

Also, properly check your feet after every session for any blisters or irritations. Moisture-wicking socks or gel insoles might help with feet protection.

If you need help, hire somebody

This is especially important, if you're new to exercise. Consider booking a few workout session with a personal trainer, who is experienced in working with people that suffer from diabetes.

Hiring a professional can be very beneficial to learn the basics and avoid injuries. But don't with the next best "personal trainer" at your local low cost gym. If you spend the money, get somebody with experience and a proven track record.

Make sure to drink enough!

Getting enough fluids in before, during and after your workout is crucial. Don't wait until you're thirsty, because then you're already significantly dehydrated. Aim for 1 litre per 20 kg/10 lbs of body weight per day.

Track workouts, meals, medications and blood sugar levels


It can be very motivating to track every workout session and seeing improvements.

But that's not all: Analysing journal entries helps to spot patterns and figure out how your body reacts to different types of exercise and food.

Something isn't working? Change one variable at a time and see if that helps. Maybe you need to change your pre-workout meal or how much insulin you have to take. All this will be much easier to figure out, when you keep tracking everything in a journal.

Plus, stick to the same routine and diet for at least 3 to 4 weeks, so it's much easier see trends. Trying stuff for 2 days in a row is just not enough, to see results.

Reconsider your insulin levels

If you're working out regularly and you're on medication, you could consider changing your insulin levels. Why? Working out will increase your insulin sensitivity. A lot.

If your blood sugar levels are consistently high or low throughout the day, it might be time to adjust your medication.

Get a training partner

It can be a huge motivation to train together with a friend or somebody who is on the same mission.

Furthermore, you will be more likely to stick to your new workout routine, if you know that there's somebody waiting for you to come. Accountability is a huge factor for success!

There are workout groups in most cities and you can join Facebook groups for tips and support. A supportive and helpful community can make a huge difference.

Never give up!

Becoming more active has only good sides, even if you don't see or feel all of them right away.

Stick with it, even if it sucks and you'll soon see the results.

Conclusion

Keep in mind, exercise and diet should go hand in hand. Even if you exercise regularly, a diet rich in sugar and unhealthy fats and with just very little micronutrients can not be out-run.

On the other hand, if you are on a healthy diet, but you rarely move, your cardiovascular health will suffer at some point. Your body needs both!

So get out there and kick butt!

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