Written by: Dr Lau Bik Kui, Consultant Endocrinologist & Physician, KPJ Kuching Specialist Hospital
Exercise has benefits for everyone, including people with diabetes, especially when combined with healthy eating. Unfortunately, 1 in 4 adults in Malaysia are physically not active1. There is still a major misconception about physical exercise among people with diabetes and their immediate family members2.
Putting together an exercise plan can be an agony if we aren’t into regular exercise. But remember, along with diet and medications, regular physical activity is an important part of managing diabetes or dealing with prediabetes. Being active makes our body more sensitive to insulin (the hormone that allows our body cells to use blood sugar for energy). This helps our body to regulate blood sugar more effectively.
All forms of exercise — aerobic, resistance, or doing both (combined training), are equally beneficial for people with diabetes3/4. Exercise just makes us feel better, no matter where we are physically — as long as we start doing something now.
• Find something you like.
If you don’t like it, you won’t stick with it. Find an activity that you and your health care provider agree you do regularly for the best results.
• Start small.
If you have never exercised before, start with low impact exercise such as walking and go slowly. This helps to build exercise tolerance and prevent injuries. Start small and gradually add a little more time and intensity each week.
• Find a “kaki”.
It’s more fun when someone else is counting on you to show up. Having a exercise partner always help to motivate us to continue to be active.
• Pick a goal.
An example of a goal could be to walk 10,000 steps every day for month or to be active every weekday for 30 minutes. Be specific and realistic. Always discuss you activity goals with your healthcare provider.
• Schedule it in.
Think of ways to link physical activity into daily life. For example, use staircase instead of lifts, park our vehicles further, and walk (instead of driving) for grocery shopping. The more regular activity we do, the quicker it will become a habit.
It is always advisable to discuss with your healthcare provider about the physical activities you like — how to prepare, what to avoid.
People who have had diabetes for a long time or those who constantly have high blood sugar level are at higher risk of developing diabetic foot problems. Hence, it’s essential to use well-fitting socks and shoes, and the right footwear for the activity we are doing. After physical activity, inspect the feet for sores, blisters, irritation, cuts, or other injuries. Seek help if an injury doesn’t begin to heal after 2 days.
In general, the best time to exercise is one to three hours after eating, when our blood sugar is likely to be higher. Exercise causes our muscles to use more glucose, so it can lower body blood sugar. It is important for people with diabetes to keep track of their blood sugar before, during and after exercise.
Low blood sugar (also known as hypoglycaemia) occurs when blood sugar is below 4mmol/L. When this occurs, eat a small snack containing 15-30 grams of carbohydrates, such as half cup of fruit juice or regular soda (not sugar free), 3 pieces of cream crackers, or 2 tablespoons of raisins. Always recheck the blood sugar 15 minutes later to ensure the level has improved to above 4mmol/L.
On the other hand, hyperglycaemia occurs when blood sugar is too high (over 11mmol/L). This increases the risk of dehydration, so increase fluid intake to stay hydrated when exercise is important. More alarmingly, certain group of diabetes are at risk of developing a build-up of ketones (ketoacidosis) if they exercise with high blood sugar level — such as people with type 1 diabetes, people with type 2 diabetes who are requiring high doses of insulin (high insulin resistance), long standing poorly controlled diabetes, and those who are on certain class of antidiabetic medication (eg SGLT2-inhibitors).
Consider to test urine or blood for ketones. The presence of ketones indicates that the body doesn’t have enough insulin to control the blood sugar. If you exercise with high ketone levels, you risk ketoacidosis - a serious diabetes complication that needs immediate treatment.
Finally, after your activity, check to see how it has affected your blood glucose level.
Having diabetes is not a barrier to actively enjoying sports and exercise. We are always one workout away from a better self. Let’s move our body today!
1 NHMS 2019.
2 Amulya R. Sircar et al. Patients’ concepts and attitudes about diabetes. Journal of Diabetes and Its Complications 24 (2010) 398-403.
3 Ronald J Sigel et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes. Ann Intern Med. 2007; 147:357-369.
4 4. Timothy S. Church et al. Effects of aerobic and resistance training on haemoglobin A1c levels in patient with type 2 diabetes — A randomized controlled trail. JAMA. 2010;304(20): 2253-2262.
5 5. Sheila A Ward. Diabetes, exercise, and foot care: minimising risks in patients who have neuropathy. Phys Sportsmed. 2005; 33(8):33-38.
6 6. 6. Michael C Riddell at al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diab & Endo 2017; 5: 377-390.