How To: Exercise

There is no getting around this section. The only skipping I want to see here is something you do repetetively with a rope! 


If you are not used to exercise:
 
Gentle walking building up to 30 minutes every day.
 
Gentle weight training starting with very light weights or rubber bands.
 
Gentle yoga or stretching
 
Tai chi.
 
Chair based exercises. In the UK both Lizzie Web and Rosemary Conley have dvds/videos with these and other exercises. Amazon.co.uk rents fitness videos. Try before you buy.
 
Why not see if you can join a pensioners keep fit class at your local hall? If you are not a pensioner explain that you are extremely unfit and would appreciate a gentle introduction to fitness.
 
ANYONE WITH MORE THAN BACKGROUND RETINOPATHY WHO HAS NEW VESSELS NEEDS TO SEEK ADVICE ON EXERCISE.  Any jarring activity such as jogging or trampolining could rupture the delicate blood vessels and cause a bleed into the eye. Upside down postures in yoga and serious weight training must not be done.
 
 
If you are somewhat used to exercise:

 
Interval / Circuit training.
 
Moderate weights
 
Yoga. Pilates.
 
Aerobics / Fitness / Dance classes building from 15-60 minutes.
 
Video tapes and dvds.  These cost almost nothing at car boot sales. You can also rent fitness videos from amazon.
 
Why not join a gym or regular class?  You will get expert tuition. Weight machines tend to be safer than free weights for novices.
 
THOSE WITH CARDIOVASCULAR IMPAIRMENT OR AUTONOMIC OR PERIPHERAL NEUROPATHY NEED EXERCISE ADVICE.  Unaccustomed exercise that raises your heart rate could be risky. Shoes must be well fitting and suitable for the task.

If you are trying to lose weight, exercising after meals can work well. You don't need to eat extra food and cutting back on insulin promotes the loss of body fat.  

Physical activity can make muscle cells more sensitive to insulin for many hours after activity eg 12-24 hours for vigorous and prolonged activity say at a school sports day or a strenous hill walk.
 
Certain exercises have little or no impact on blood sugars eg light weights with frequent repetitions.
 
Other exercises can produce a short term bood sugar rise:  
 
Heavy weight lifting with low repetitions.
 
Sports with bursts of activity eg golf, running, swimming and rowing, sprinting.
 
Sports where you are being judged eg gymnastics.
 
Sports when winning is the primary objective eg football.
 
   
Measures you can take to offset hypoglycaemia after exercise include:
 
Lowering the basal insulin at night if you are on a pump or on Lantus or Detemir at bedtime.
 
Have an extra snack.
 
Reduce any meal boluses or correction boluses at bedtime.
    
If you have high blood sugars and not enough insulin available, you can tip yourself into Diabetic Ketoacidosis by more exercise.  
 
As long as you have sufficient basal insulin however light exercise that does not stress you can be a helpful way to get your blood sugar down. This tip is especially helpful for people on fixed insulin doses who are not in a position to give a correction bolus.
 
You can see that matching up food and insulin to sports can be a tricky business. Unfortunately advice from exercise physiologists does not appear to be available in the UK in the way it is for diabetics in the US.  
 
Joining an internet forum for diabetic exercisers may be the most pragmatic approach to getting advice on this if you are particularly sporty or competetive.
 
 
If you are a fitness fanatic
 
Keep doing what you are doing.
 
Add in any missing components to your regime such as stretching, relaxation, balance, aerobics or weights / toning.
 
Type ones  may need detailed advice about their insulin regimes especially at competetive level. This one to one work is not available on the NHS but would be well worth having. www.diabetes-exercise.org is the home page of the Diabetes, Exercise and Sport Association. (USA)
 
Why not buy Gary Scheiner's book, Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin  It is a good start and he says he will answer questions online.  He is a type one pumping exercise physiologist.  
 
Sheri Colberg has written a book,The Diabetic Athlete.  Sheri has also recently completed a series of articles about getting fit at the internet site www.diabetesincontrol.com  They are geared towards those of us who are simply not sure where to start and are a very helpful introduction to excercise and fitness.
 
John Walsh and Ruth Roberts book, Pumping Insulin: Everything You Need For Success On A Smart Insulin Pump has a detailed section on how to modify diet, basals and boluses for certain activities, intensities and durations. It could be adapted by those on a multi dose injection regime.
 
If you are working very hard physically you may wish to consider switching to an insulin pump because the basal levels can be altered with considerably more finesse than with one or two basal injections a day. This can help a great deal with the post exercise delayed hypoglycaemia problem.
 
If you are not working to any extent physically you may wish to consider looking at the types of exercise that could suit you in the metabolic section.  If you are working out a little and feel you could handle a little more there is information for you too.  
 
Exercise Tips for Kids of all ages
Spike and Bo Loy have edited a book of tips from diabetic kids called, "478 Tips for Kids with Diabetes."  This is published by the ADA.  Here are somethings their young contributors would like everyone to think about when it comes to exercise.  
 
Always tell your teacher, team mates and class mates that you have diabetes and give them information about how to recognise and handle emergencies such as low blood sugar or vomiting.
 
Carry a bottle of water with you.
 
If you feel low come out of the activity, consider testing, eat a snack, then return.
 
Test frequently to see how your body reacts to different patterns of exercise.
 
Test before you start. If you are low or normal have a small snack to prevent a drop later on.
 
While you are active you may want to drink diluted gatorade or lucozade as you go along.
 
If you get overheated blood sugars can drop fast.
 
Because insulin absorption soars in hot water don't inject right before you get in a hot tub or bath.
 
When you go swimming disconnect your pump and put a cap on the infusion site.
When you take your pump off keep it in a cool place.
 
You may want to give yourself a lower temporary basal rate to avoid low blood sugars after exercise.
 
Many pumps are waterproof but none of them float. If they are lost they cost !
 
Watersports need more vigilance than others.
Never swim alone.
Eat before you go.
Consider putting a little tube of hypostop gel/icing in your trunk pocket.
 
Come back every hour to test, eat and drink.  
If you are pumping you may need to come back for more insulin.
 
Consider lowering your short acting insulin before heavy exercise.
 
If you have forgotten your hypo kit at an exercise session sprint as fast as you can in 30 second bursts towards the end of the session to stop you going low.
 
If you are skiing, keep the insulin pump next to your body to prevent the insulin from freezing.  Keep your meter warm too or the batteries won't work.
 
Being at high altitude lowers blood sugar.

The deeper and colder the water, the more carbs you burn when you are diving.
 
If you leave food on the beach make sure animals cannot get into the cooler and eat it.  
 
Test 30 minutes and right before exercise to see if your blood sugars  are tending to rise or drop.


Quick Quiz:
1. Three of these exercise regimes are harmful to diabetics with proliferative retinopathy. One is okay. Which one?
     a Trampolining.
     b Jogging.
     c Walking.
     d Heavy weight training.

2. Three of these exercise regimes are suitable if you are very unfit. Which ones?
     a Circuit training.
     b Tai chi.
     c Gentle stretching.
     d Chair based workouts.

3. Three measures type ones can take to offset night time hypoglycaemia after exercise include...
     a Eat more at bedtime after prolonged strenous exercise.
     b Lower the basal insulin at night after prolonged strenous exercise.
     c Decrease the meal or correction boluses at bedtime.
     d Avoid any exercise as it makes blood sugar control too difficult.

Have you got it?
1. ACD are jarring activities and weight training additionally raises pressure in the eyeball. These factors can cause the delicate new vessels present in proliferative retinopathy to rupture. The bleeding into the eye can often cause visual loss. Stick to walking, swimming and static exercise bikes if you have proliferative retinopathy. By the way, skipping is out too!

2. BCD are fine. Circuit training is really for people who are pretty fit already. You are aiming to gradually improve your fitness levels.

3. ABC can all be appropriate. The whole issue of adjusting food and insulin to your exercise regime can be very tricky indeed. Physical activity to improve your cardiovascular fitness, strength, flexibility and mood will however help you on the long term and can be a great source of pleasure.

Where to Next?
Are you a bit puffed just thinking about how the new you is going to be doing things a bit differently and a bit more? Well, I think you could do with a little break. Get yourself a low carb drink of your choice and sit down at your computer for a little browse in the  How To: Find Information Online section--everyone will benefit from this section too.

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