The journey of a thousand leagues starts from where your feet stand. You may have heard the proverb. Exercise is like that. It all boils down to single steps you take each day. It can be as simple and as difficult as starting any journey. There's no question, taking that first step can be hard. Maybe you've never exercised. Maybe you used to but stopped. Maybe you've just been diagnosed with diabetes and feel like you'll never be fit again. We've all got plenty of reasons not to exercise.
We're:
Too old.
Too fat.
Too weak.
Too sick.
Too busy.
Too tired.
What we need to remember is that it's never too late. With few exceptions, even if you're disabled or injured you can still improve your level of fitness. Once you get going, you'll be amazed how quickly your excuses fade.
Too old? Join a class with others in your age group. There are seniors' mall-walking clubs, water exercise classes, senior stretch programs, even chair aerobics classes. Check your local YMCA, YWCA, or county recreation program. Nothing in your area? Start your own program with a partner, such as a relative or friend.
Too fat? If you feel too awkward or embarrassed to exercise, join the club. Most people feel slightly silly when they start out. Exercise is not just for skinny minnies. In fact, once you get going, look around. Few regular exercisers have perfect physiques. Most fitness buffs will respect your efforts and root for your success. If you're trying to lose weight, even a modest amount of regular physical activity can help.
Too weak? Regular physical activity will help you have more strength and energy for daily tasks.
Too sick? Of course, you can't exercise when you're ill or when your blood glucose levels are out of control. But once you are feeling better, regular physical activity will help you stay well. If you stick with it, you may even find you don't get sick as much and may need less medication.
Too busy? You don't have to spend hours exercising to see a health benefit. Depending on your fitness level, you may need to start with as little as 10 minutes of walking three times a week. If you really want to make a change, you can find ways to get more activity into your daily routines. Park farther away from the entrances at the mall. Plan an after-dinner walk with someone you want to talk to. Ride a stationary bike while you watch the morning or evening news.
Too tired? Believe it or not, regular physical activity will give you more energy. Toning your muscles and conditioning your heart, lungs, and blood vessels will better equip you to handle the work and stress of daily life. Lots of people think of exercise programs the way they think of diets. They plan to get in shape for a certain event. Or they join an exercise class hoping it will help them lose 5 or 10 pounds. But physical activity and healthful eating are habits we need to stay with over the long haul. That doesn't mean doing the same exercise or eating the same meals forever.
You may enjoy trying new forms of physical activity, in the same way new recipes are fun. Or you may find an activity that works for you and stay with it.
The First Step
The first step to fitness is a visit to the doctor. Before you begin any exercise program, get a thorough medical exam.
The exam should check:
Blood pressure
Blood fat levels
Glycohemoglobin and current blood glucose level
Health of heart and circulatory system
Body composition (fat versus lean)
Eyes
Feet
Your doctor should help determine your level of fitness. You need to know what types of exercise or exercise programs are good choices for you. Some complications of diabetes make certain types of physical activity bad choices. The benefits of an exercise program need to outweigh the risks. If possible, get an exercise prescription. This is an exercise plan that takes into account your current level of fitness, special health concerns, and your diabetes treatment plan. Your health care providers are your best resources.
Set Goals
Goals help give shape to your exercise plan. They give you something specific to work toward. Reaching a goal marks your success. Setting new goals keeps you going. Start out by asking yourself why you plan to exercise.
Do you want to:
Feel better?
Move easier?
Lose weight?
Get stronger?
Have more energy?
Reduce stress?
Stay fit while learning to live with diabetes?
Reduce your risk of diabetes complications such as heart disease?
Get your doctor or partner to stop nagging you?
Once you know why you plan to exercise, talk with your doctor about realistic ways to reach your goal. With your doctor or exercise specialist, you can plan an exercise routine with your goal in mind. Your program will need to take into account your diabetes management routine.
Your doctor and diabetes educator can help you plan:
The best times to exercise
When to test your blood glucose levels and what your test results mean in terms of exercise How to avoid problems with low blood glucose levels
How to inspect your feet before and after exercise Other specific health concerns.
Here's how this might work. Suppose you have Type 2 diabetes and are overweight. You work in an office and drive to work. You don't have an exercise plan. Your doctor says that if you lose some weight and start to exercise, you may be able to improve your blood glucose control.
After your physical exam and an exercise stress test, the doctor says you can start a walking program.
Your health goal: to lose 10 pounds.
Your fitness goal: to stay with a regular walking program for 3 months, building up to 20 minutes of walking three times a week. Current fitness level: couch potato.
Now you need to break your fitness goal down into smaller steps. Make your goals realistic, measurable, and achievable. Your long-term goal is to walk for 30 minutes three times a week. Your short-term goal is to walk 10 minutes without stopping three times a week for a month.
Write your goal down. Keep a log, or diary, of your exercise. You can buy a special notebook, write on your calendar, or make a note in your blood glucose record book. You might also want to jot down how you feel while exercising, or any problems you have. This gives you something to look over when you're ready to make changes.
When your goal period is up, look at your log.
Were there good days and bad?
Did you start feeling different?
As you set your new goal, use your log to decide on changes. Do you need to reduce your level of physical activity?
Or are you ready to move up a notch?
Discuss changes with your health care team. Be sure to reward yourself when you reach a goal.
Knowing that physical activity is something you'll do for the rest of your life can help. You can take the long view. If your first attempt doesn't work, try again. Do something different. Join a class or a mall walkers club. Think about what you enjoy doing and find a fitness activity that matches.
Do you like to exercise to music?
To TV?
Alone or with friends?
Outdoors or indoors?
There are so many choices, you can find something to enjoy.
Fringe Benefits
You know that regular physical activity is good for your health. It also brings fringe benefits such as:
Looking better.
Meeting new friends.
Escaping from the daily grind.
Learning new skills.
Reducing stress.
Still, after you've been exercising for a while, you'll no doubt go through a spell where your motivation slips. Anyone who has a long-term exercise program has "off" days, times when he or she just doesn't want to stick with it. Or you may have a setback due to illness or injury. When it happens to you, don't mistake it for failure. Give yourself a break. Call an exercise buddy. Review your exercise log. Read an inspirational book. Try a new activity. Join a class. Celebrate your successes. Treat yourself to something new to wear when you exercise -- a new T-shirt, even new shoes. Before you know it, your exercise slump will be over.
Exercise helps pep up insulin's action. Exercise can improve your health and your outlook on life. Because you have diabetes, however, it pays to be doubly careful not to injure yourself or upset your diabetes control. You should follow the basic guidelines that everyone who exercises needs to follow. And you'll want to add some extra safety steps that take your diabetes into account. These 20 tips for safe exercise will help you deal with both of these needs.
1. Get a thorough medical exam before you start. Your doctor should check your
blood pressure
blood fat levels
glycated hemoglobin levels
health of heart and circulatory and nervous systems
kidney function
eyes
feet
2. Choose exercises that fit your health. Talk to your health care team about what types of exercise are best for you. Diabetes can cause health problems, such as eye or nerve disease, that make certain types of exercise poor choices. For example, if you have lost feeling in your feet, swimming may be better than walking. If you have trouble seeing or have frequent low blood glucose reactions, you may need to exercise indoors or with a friend. Your health care team can help you choose fitness goals tailored to your health.
3. Take it easy. Slow and steady wins the race. Trying to do too much too soon can leave you discouraged or even injured. One way to pace yourself is to count your heart rate and make sure it stays below a certain level. Another is to rate how difficult exercise feels and avoid too much huffing and puffing. Your health care team can teach you how to avoid pushing yourself too hard. Step up your workout as you become more fit. Gradually increase how long and how hard you exercise. For instance, you may start out walking for just 5 or 10 minutes. Over many weeks, you may build up to 25 or 30 minutes. You and your health care team should adjust your plans for exercise, meals, and medications as you get in shape.
4. Warm up and stretch when you start exercising. Warm up with a low-impact exercise like walking. This gets your heart and muscles prepared to work. After you are warmed up, you may want to stretch gently. Stretching helps keep muscles and joints flexible. Tight muscles and joints are more prone to injury.
5. End your workout with a cool-down. Slow down gradually, until your breathing becomes more normal. For example, if you've been jogging, walk for 5 minutes to cool down. Some people prefer to stretch at the end of their workout, when muscles are warm and can stretch more easily. When your breathing is back to normal, start your stretching routine.
6. In addition to exercise that conditions your heart and lungs, try weight training. Almost everyone with diabetes can work out with light weights. You can enhance your upper body strength with an exercise program that features many repetitions with light, hand-held weights.
7. Drink plenty of fluids. Sweating means you're losing fluid. It's important to drink to replace fluids lost in sweat. Water is usually the best choice. If you are exercising for a long time, you may want the extra calories in a drink that contains carbohydrate.
8. Wear clothes that are right for the weather and your sport. It won't help to wear heavy clothes in the warm weather. Sweating more won't help you lose fat, just water weight. In fact, it's unhealthy. You'll just increase your risk of overheating. In the summer, wear lightweight, light-colored clothes. Be sure to use sunscreen and wear a hat. In winter, dress in layers. Polypropylene, silk, or thin, fine wool make a good first layer. These materials help lift sweat from your body and prevent chafing. Your outer layer should be made of material that can "breathe" and let sweat escape. Be sure to protect your feet, hands, and head from the cold. Use the safety gear that goes with your sport. If you're cycling, wear a helmet. If you're playing racquetball, wear eye protection. Avoid exercising when it's too hot or too cold to be outside comfortably. It's unhealthy to exercise outside when air quality is poor.
9. Remember your feet. Wear the right shoes for your sport. This means basketball shoes to play basketball, walking shoes for walking, aerobics shoes for aerobics, etc. Replace shoes when they begin to wear out. Always put on clean, smooth-fitting socks. Check your feet after exercise. Look for blisters, warm areas, or redness. If you do see problems, call your doctor.
10. Watch for low blood sugar. If you take insulin or oral diabetes medicine, you may have low blood sugar levels during and after exercise. In fact, you may get low blood sugar 12 or more hours after a workout. People who have Type 2 diabetes that is controlled by meal planning and exercise usually don't have problems with low blood sugar. Glucose fuels your muscles during exercise. At the same time, exercise helps pep up insulin's action. Both things lower your blood sugar level. Through careful planning, you and your doctor will learn to adjust your insulin treatment to avoid low blood sugar levels caused by exercise.
11. Check your blood sugar before you exercise. If you take insulin or diabetes pills, self-monitoring of blood glucose is the key to avoiding low blood sugar levels. One good idea is to test your blood sugar twice before exercise. Monitor 30 minutes before and again just before you begin, so you'll know whether your blood sugar level is stable or dropping. If it is dropping, you may need an extra snack.
12. Be ready to check during exercise. This is especially important when you are trying a new activity or sport. A check can help you predict how this sport will affect your blood sugar levels. You should also check if you will be exercising for more than 1 hour. Generally, you'll want to test every 30 minutes. If your blood sugar starts to fall, stop and have a snack.
13. Test again after exercise. Exercise-especially long, hard workouts-can lower your blood sugar for hours after you've stopped. This happens because workouts draw on your body's supply of glucose, stored in your muscles and liver as glycogen. Later, your body rebuilds its stores of glycogen by taking glucose from the blood. For up to 24 hours, your body needs the glucose you get from meals to fill up your glycogen stores. Your health care team can suggest at what times you should do extra checks to avoid low blood sugar.
14. Use your monitoring results to learn how exercise affects your body. Exercise makes insulin work harder. Your blood sugar may drop more than usual when you take your normal insulin dose. Exercise can make insulin go to work faster, too. On the other hand, if you have type 1 diabetes and have too little insulin available, hard exercise sessions can raise your blood sugar. Hard exercise can signal your liver to start breaking down glycogen into glucose. Hard exercise means whatever is difficult for you. Remember to test for ketones whenever your blood sugar levels are too high (see step 19). If you take insulin or diabetes pills to control your blood sugar levels, you need to plan your exercise and diabetes care to avoid levels that are too low or too high.
15. Time your exercise according to your meals and insulin. Generally, you want to exercise after you have eaten. The food will help keep your blood sugar from becoming too low. It's best to exercise 1-3 hours after a meal. You should also avoid exercising when your insulin is peaking (at its strongest). Avoiding your insulin's peak times will help you avoid low blood sugar. Your doctor may suggest that you try decreasing the insulin dose that will be working while you exercise.
16. Ask your health care team for tips about snacking and exercise. In general, exercise lowers blood sugar levels. This can be good or bad, depending on your blood sugar level before you start to work out. If you have Type 1 diabetes, and your pre-exercise sugar result is under 100 mg/dl, exercise could lower glucose too much. Have a carbohydrate-containing snack before beginning to work out. Keep another snack handy to avoid low blood sugar levels during to exercise. On the other hand, people with Type 2 diabetes should limit snacking to assist in weight loss. Snacking before exercise will undermine your efforts. It will also work against the power of exercise to lower glucose levels.
17. Be prepared to treat low blood sugar. Always carry juice, regular (nondiet) soft drink, glucose gel, raisins, or another fast-acting source of sugar. If you feel a reaction coming on, stop, test, and treat it right away.
18. Know when not to exercise. If your fasting blood glucose is more than 300 mg/dl, no matter what type of diabetes you have, it is in poor control. Don't exercise before you bring your glucose levels back down or before checking with your health care team.
19. Know when to test for ketones. If you have Type 1 diabetes and your blood glucose tests are 250 mg/dl before exercise, stop and test for ketones. If you test positive for moderate or large amounts of ketones, do not exercise. Ketones are a sign that your insulin level is too low. Exercise could cause the body to make more ketones. Ketones add acid to the blood. When too many ketones are produced, they disrupt your body's chemical balance. This can be dangerous. Wait until your tests show negative or trace ketone levels before beginning to exercise.
20. Update your exercise plan regularly. If you take insulin or diabetes pills, talk to your doctor about exercise and your blood sugar levels. Ask your doctor to tailor exercise guidelines to meet your individual needs. Once you get going in a regular exercise program, you may find that you need less insulin or lower doses of diabetes pills. Your doctor may also be able to teach you how to change your own insulin dose on days when you plan a different exercise routine. Exercise with diabetes does demand a few extra safety steps. You'll find that, once you're into regular exercise, these will become a part of your routine. And the rewards of exercise are well worth a little extra effort.
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