Exercising Safely with Diabetes: Exercise in Management of Diabetes  

What is Type 2 Diabetes Mellitus?  

Type 2 Diabetes Mellitus (T2DM) is the most predominant type of Diabetes, affecting 85-90% of all people with diabetes (Exercise Right, 2022). The condition is characterised by long term elevated fasting blood glucose levels due to the inability of the body’s cells to effectively utilise insulin, also termed insulin resistance, and a reduction in insulin production from the pancreas. There are multiple risk factors for developing T2DM including inactivity, pre-diabetes, family history, increased blood lipid levels, increasing age, and being overweight or obese.  

What is Type 1 Diabetes Mellitus?  

Type 1 Diabetes Mellitus (T1DM) is a chronic autoimmune condition where an individual’s pancreatic B-cells are destroyed, resulting in a build up of glucose in the blood stream. T1DM is a genetic condition and not related to lifestyle and modifiable risk factors alike T2DM.  

Importance of Exercise for Managing Diabetes Mellitus:  

Eventually, high blood glucose levels can result in unwanted health concerns including heart and cardiovascular diseases, nerve damage, kidney failure, foot conditions, eye damage and many others. The good news is that exercise is considered a first line and vital treatment for all individuals with Diabetes, especially T2DM. This is because physical activity improves glucose uptake into active muscles, and can thus improve systemic insulin action for up to 72 hours. Overtime, this can result in importantly lower HbA1c levels and improved insulin sensitivity, in addition to multiple other health benefits including improved aerobic capacity, improved muscular strength, reduced cardiovascular disease risk, and an improved sense of overall wellbeing. 

Exercise Precautions for those with Diabetes:  

Despite there being general exercise recommendations for those with diabetes including engaging in a combination of both aerobic and resistance exercise, completing exercise modes that involve large muscle groups, and exercising every 48 hours to maximise the acute blood glucose lowering effects that exercise offers, chatting with an accredited exercise physiologist is always important to ensure you are receiving the best advice regarding your exercise routine. This is particularly necessary for individuals with Diabetes as this condition is associated with a number of precautions and considerations with regards to exercise which we are going to delve into a little bit more.  

Blood Glucose Levels:

To begin with, monitoring blood glucose levels before, sometimes during, and after exercise reduces the risk of having a hypoglycaemic or hyperglycaemic event, as exercise generally increases the risk of experiencing a hypo in particular. A hypoglycaemic event involves the lowering of blood glucose levels below safe levels and may involve symptoms of nausea or vomiting, light-headedness, excessive hunger, blurred vision, mental confusion, shakiness, sensations of pins and needles, and headaches. On the other hand, a hyperglycaemic event involves blood glucose levels higher than normal or safe which may cause someone to have frequent urination, feel tired, have blurred vision, have lost weight, or feel excessively thirsty. It is important to note that everyone’s blood glucose levels respond differently to exercise types and intensities, and thus an individuals’ safe glucose levels are not always clear cut. This is particularly relevant when diabetes medications are involved.  

Medications:  

Individuals who have been prescribed Diabetes medication should understand their medication side effects and consider this when exercising. To begin with, many medications can influence blood glucose levels and commonly can increase our risk of having a hypo when combined with exercise. For this reason, medication doses, the timing of exercise, and the consumption of carbohydrates before or during activity may need to be considered. In particular, medication alterations or changes need to be discussed with your doctor within a blood glucose management plan. Furthermore, if you are taking insulin, avoiding exercising the injection site is also a consideration.  

Other Considerations:  

There are many other considerations surrounding exercise and Diabetes that your Exercise Physiologist can provide advice upon. Some of these entail comorbidities such as Peripheral Neuropathy, which presents the importance of not engaging in weight bearing exercise if you have any foot ulcers or sores, and being at an increased falls risk. Those with Autonomic Neuropathies need to be mindful of having impaired thermoregulation, reductions in heart rate and blood pressure responses to exercise, orthostatic hypotension, and exercising at lower intensities to begin with. Finally, type one diabetics should also monitor their ketones as those at 0.6 or above are contraindicated to exercise.  

Overall, there are many things you can do to improve your diabetes management including exercising safely by the help of health professionals!  

Hannah Bain.  Accredited Exercise Physiologist (True North Wellness)