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Diabetes: How exercise helps

With the current skyrocketing incidence of diabetes in children and adults, the role of exercise in preventing the disease and reducing the disease's debilitating complications becomes increasingly vital.

Do You Know Your Numbers?

Hemoglobin A1C
"The most important test for diabetes is the hemoglobin A1C test, which is a measure of your average blood sugar," says Dr. Charles Clark, professor of medicine at Indiana University School of Medicine and chair of the National Diabetes Education Program. A healthy person without diabetes will have an HbA1C value that ranges between 4 percent and 6 percent. A level above 8 percent indicates diabetes, in 98 percent of cases.

Waist Measurement
Doctors often check the distance around your waist as a marker for abdominal fat. Evidence strongly suggests that an unequal distribution of body fat around the abdomen (the apple shape) is a more consistent predictor of heart problems and health risks than BMI.

By Carol Krucoff and Mitchell Krucoff, M.D.

From the March/April 2004 Issue

Exercise was recognized as an important therapy for diabetes as far back as the Sui dynasty (about 600 A.D.), when a famous Chinese doctor of that period, Ch'ao Yuen Fan, advised patients suffering from diabetes-related diseases to "walk one hundred and twenty steps or more, not to exceed one thousand steps" before each meal.

Walking and other forms of exercise help prevent and manage diabetes be cause they affect the very thing that needs to be controlled in this condition--blood glucose levels. When people exercise, the body fuels the activity by taking glucose out of their blood to use for energy. This lowers blood glucose levels, which can be extremely therapeutic in a disease characterized by elevated blood sugar.

But lowering blood sugar is just one mechanism by which exercise helps. Regular exercise also has important metabolic effects that influence the condition, including:

• Improving the body's ability to use glucose. This means that when people exercise regularly, the amount of insulin they need decreases.

• Increasing the body's sensitivity to insulin. This can help reverse the insulin resistance that often occurs when people become overweight.

• Aiding glucose transport. Contracting muscles help stimulate the movement of glucose throughout the body.

• Helping people control their weight. Weight loss reduces blood glucose levels, improves insulin sensitivity, and helps reduce risk of heart disease. Yet when people try to lose weight by diet alone, the body often reacts by slowing the metabolic rate to conserve energy. Not only does this mean that they burn fewer calories, but when they do lose weight, much of it comes from lean tissue--which means muscle and bones. When people begin to exercise regularly--and embark on a healthy diet--the weight they lose typically comes from fat. In particular, physical activity promotes fat release and utilization and helps people reduce the amount of abdominal fat (also known as the "spare tire") that is associated with diabetes.

Exercise also boosts the health of people with diabetes because it:

• Helps prevent cardiovascular disease, which is the leading killer of people with diabetes.

• Relieves stress and enhances mood. Stressful events can prompt a release of adrenaline, which can raise glucose levels in the blood. Physical activity exerts a calming effect and relieves symptoms of depression and anxiety. Regular exercise also prompts a sense of mastery and control that can be particularly helpful to people forced to cope with a chronic disease.

Exercise may reduce--or eliminate--the need for diabetes medication. Since exercise makes blood glucose levels fall, some people with type 2 diabetes who take drugs to manage their condition find that after they start exercising regularly, they no longer need the pills. People with type 1 diabetes, whose bodies don't produce insulin, typically require a lower dose of injectable insulin when they exercise.

Exercise alone will not improve glucose control in people with type 1 diabetes, although it can be important in managing the condition and avoiding complications. Since people with type 1 diabetes are at risk for low glucose levels (called hypoglycemia), they must be careful to monitor their blood glucose before and after exercise to avoid low blood sugar, also known as an "insulin reaction." Low glucose levels can be dangerous for people with type 1 diabetes because it can cause confusion, irritability, lack of coordination and, in extreme cases, unconsciousness or convulsions.

Finding a healthy balance between food (which makes blood glucose levels rise) and exercise and insulin (which make blood glucose levels fall) can be a delicate juggling act for people with type 1 diabetes. In fact, before home blood glucose monitors were developed in recent years, physicians typically discouraged people with type 1 diabetes from engaging in excessive endurance exercise to avoid dangerous low-blood-sugar reactions. This was extremely frustrating for many athletically inclined people with type 1 diabetes.

For example, back in the late 1970s, doctors warned Paula Harper not to run a marathon because she had type 1 diabetes, but the nurse and mother of three from Phoenix chose to ignore them. "I noticed right away that the more activity I did, the less insulin I needed," says Harper, who in 1985 founded the International Diabetic Athletes Association. Racing with a T-shirt that proclaimed, "I run on insulin," Harper has completed more than 30 marathons, a 50-mile ultramarathon, five triathlons, and six bicycle races over a hundred miles long. "In retrospect, what I did seems scary," she admits. "But I knew that running made me feel better and helped me cope with my diabetes."

Today, people with diabetes participate in virtually every sport--from scuba diving to sky diving--and at all levels of competition. Many world-class athletes have the disease, and famous competitors with the condition included Arthur Ashe, Ty Cobb, Sugar Ray Robinson, and Jackie Robinson. Over the last decade, physicians have increasingly recommended exercise as one of the most effective ways to prevent diabetes among people who don't have it and to help those people who do lead normal lives and reduce their risk of serious complications.

Exercise Rx

It's essential that people with diabetes develop an individualized exercise program with the guidance of their physician, because each person's metabolism reacts differently to the balance of activity, food, and insulin. Also, exercise can have special risks for diabetics, including hyperglycemia and the exacerbation of existing diabetes-related complications such as heart arrhythmias, eye problems, and lower-extremity injury. That's why it's important that a physician examine you for underlying cardiovascular disease or related complications. Be sure to discuss all the specifics of your exercise regimen with your doctor, including:

• Frequency, duration, and intensity of exercise.

• Time of exercise in relation to insulin administration. (Many experts recommend testing blood glucose before and after exercise.)

• Time of exercise in relation to meals.

• Kind of exercise and its impact on specifics of your condition.

• How to avoid problems.

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