Making exercise Part of your daily life

By Kathryn E. Ackerman, MD, MPH

We’ve all heard about the benefits of exercise: “More energy! Better mood! Weight loss! Lower cancer risk! Stronger bones! Lower cholesterol!” The list goes on and on. So why doesn’t everyone get out there and get with the program for a stronger, happier, healthier, sexier self?!

Because it’s a lot of work. Add your diabetes to that and it can be really tough. Exercise takes time. It can be tiring. Blood sugar levels can be all over the place. Hypoglycemia [hie-poh-gly-SEEM-ee-ah] (low sugar levels) can occur in the middle of a good workout and it can even creep up on you hours later.

Here are some suggestions to tackle a few of the biggest hurdles to exercise.

I have no time

There are 24 hours in the day. On those days when you feel like you just can’t find the time,

  • park the car farther away from work or get off at an earlier bus stop and walk the rest of the way at a brisk pace,
  • use the stairs
  • carry your kids around
  • shovel
  • jog with the dog

Scheduling a daily session on your calendar can be helpful. Mornings are good because the day usually hasn’t gotten filled up with surprises yet.

Exercise is boring

Exercise can be boring. The key to sticking with it is keeping it fun.

  • Have a workout buddy (and a backup one)! A spouse, friend, or neighbor is a good start.
  • Sign up for a class or group. For example, there are biking groups, running groups, and YMCA water aerobics classes. You are more likely to stick to your exercise if you do it with a group on a regular basis.
  • Mix it up. If you’re not training for the Olympics or being paid as a pro athlete, chances are that no one is requiring you to do a specific workout plan. Just keep moving! -Walking, running, dancing, biking, paddling, swimming, skiing, snowshoeing, mowing the lawn (not with the riding mower!), etc. It’s all exercise!

I can’t afford to join a gym or buy equipment and I don’t live in the safest neighborhood

Time to use some creativity. Try this:

  • exercising during lunchtime at work
  • using the stairs at home
  • using chairs and other things in your home to create a weight training routine
  • signing out exercise videos from the library

But I have DIABETES! Couldn’t exercise be dangerous?

Before beginning an exercise program it is important to have a medical exam and to talk about different types of physical activity with your doctor. Your doctor may have suggestions and restrictions based on your personal health issues.

I’m afraid my blood sugar will drop

It might. Sweating, racing heart, hunger, nervousness, trembling, headache, and dizziness are early symptoms. Unfortunately, these symptoms can sometimes seem just like a normal effect of a tough exercise routine. The key is to learn your body’s responses to different types and levels of exercise and to check your blood sugar often. You must check your blood sugar before, during, and after exercise.

  • A reasonable goal is to have blood sugar between 120 and 180 mg/dL before beginning exercise.
  • If you exercise for more than 1 hour, you should check your blood sugar about every 30 minutes.
  • Long workouts burn carbs (carbohydrates), so make sure that you consume carbs before and during exercise if the workout is more than 1 hour.
  • If your blood sugar is less than 70 mg/dL, stop exercising and have 15 to 20 grams of a fast-acting carb, like glucose tabs, fruit juice, or honey. It’s important that you carry fast-acting carbs with you in an easily accessible form during workouts. Wait 15 minutes and then recheck your blood glucose. If it’s less than 100 mg/dL, eat another 15 to 20 grams of carbs.
  • If your blood sugar is dropping and you don’t have an immediate snack, quickly increase the intensity of your workout (for example, start sprinting if you are running). This will cause stress hormones to increase and your blood sugar will go up for a bit while you’re getting glucose. (This is only a short-term solution until you can get a fast-acting carb into your body.)
  • Remember to check blood sugar more often after starting an exercise program. The effects of exercise often include lower blood sugars many hours after the workout is done. You need to think ahead about changing your medication dosing or snacking so that you don’t get hypoglycemia later on.
  • Keep track of your blood sugars and your training. This information will help you figure out future insulin dosing, pre-exercise meals, and snacks to have with you. You will notice patterns.

Can I exercise when my blood sugar is elevated?

  • If you have type 1 diabetes and your blood glucose is 250 mg/dL or higher, check for ketones [KEE-tones].
  • If ketones are present, do not exercise. You may or may not have DKA (diabetic ketoacidosis [KEE-toe-ah-sih-DOE-sis]), but you should drink a non-carb drink and contact your doctor.
  • If you have no ketones, and your blood sugar is between 250 and 300 mg/dL, you may exercise very carefully at a low intensity. But, you must continue to hydrate with a non-carb drink, and monitor your blood sugar often.
  • If your blood glucose is more than 300 mg/dL, do not exercise and take steps to improve your glucose control.
  • If you have type 2 diabetes and your blood sugar is 350 mg/dL or higher, you may exercise with caution at a low intensity, but continue to hydrate with a non-carb drink, and monitor your blood sugar often.
  • If you have type 2 diabetes and your blood sugar is higher than 350 mg/dL, do not exercise. Hydrate with a non-carb drink and adjust your medication/dietary regimen.

Where can I get more information about diabetes and exercise?

I’m glad you asked! - The Diabetes Exercise and Sports Association (DESA)! For more information and/or to join DESA, go to http://www.diabetes-exercise.org/.

The fact is…every little bit of exercise helps. We all need to make it a priority in our lives. You and the ones you love will benefit by learning how to exercise safely and finding ways to do it regularly.

Dr. Kathryn Ackerman is a sports medicine specialist, endocrinologist, and instructor of medicine at Harvard Medical School. Her clinic is based at Children’s Hospital Boston Sports Medicine. She sees athletes of all ages with musculoskeletal issues, general medical issues, and especially endocrine problems, such as diabetes and female athlete triad (disordered eating, low bone mass, and menstrual irregularities). She is a former national team rower and a current team physician for the US Rowing Team and Community Rowing, Inc. She currently serves on the Board of Directors of the Diabetes, Exercise and Sports Association.