Author Archives: Sheri Colberg, PhD

About Sheri Colberg, PhD

Dr. Sheri Colberg is an exercise physiologist with a world of experience with diabetes, exercise, and more. As a diabetic exerciser and researcher, she knows the latest about physical activity and its effects on your body, whether you have diabetes or not.

Do Diabetic Athlete Survey by May 15

DiabeticAthleteHandbookWebcover

Are you physically active and do you have diabetes (of any type)? Now is your chance to share how you manage your diabetes regimen while doing a variety of activities!

A new edition of Dr. Sheri Colberg’s book, Diabetic Athlete’s Handbook, is coming out in Spring 2019. Please complete the diabetic athlete survey at the link below no later than May 15 for possible inclusion.

https://www.diabetesmotion.com/athlete-survey

Please pass the survey on to everyone else you know who is active with diabetes. Thanks for your time and input!

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Get Motivated to Get and Stay Fit

Colberg ADA Workplace Photo 2You may have started the new year out with the best of intentions to increase your fitness and better manage your diabetes by exercising regularly. If you have diabetes or are at risk for developing the disease, deciding to commit to fitness could be a real lifesaver. That’s why it’s more important than ever that you make sure this decision sticks. Here are some motivational tips for getting started being more active.
Check Your Blood Glucose: When you start a new exercise, checking your blood glucose before, sometimes during, and after your workout pays off. A reading that changes — especially in the direction that you want it to — can be very rewarding and motivating. If you don’t check, you may never realize what a positive impact you can have on your diabetes simply by being active. For example, if your blood glucose is too high after you eat a meal, and you want it to go lower without taking (or releasing) any more insulin. You can exercise after your meal and bring your blood glucose down within two hours after eating and taking insulin, or you can avoid or lower post-meal spikes.
Start with Easier Activities: Start slowly with easier activities and progress cautiously to harder ones. Exercising too hard right out of the gate is likely to make you end up discouraged or injured, especially if you haven’t exercised in a while. If you often complain about being too tired to exercise, your lack of physical activity is likely what’s making you feel sluggish. After you begin doing even light or moderate activities, your energy levels rise along with your fitness, physical condition, and mental health.
Pick Activities You Enjoy: Most adults need exercise to be fun, or they lose their motivation. It’s human nature to avoid doing the things you really don’t like to do, so try to pick activities you truly enjoy, such as salsa dancing or golfing (as long as you walk and carry your own clubs). Having fun with your activities lets you more easily make them a permanent and integral part of your diabetes management. If you haven’t found any that you enjoy much, choose some new ones to take out for a test run (so to speak).
Spice It Up: It’s essential for motivation to mix your workouts up with different activities. People commonly complain about exercise being boring. Feelings of boredom with your program can be the result of repeating the same exercises each day. To make it more exciting, try different physical activities for varying durations and at different intensities. Knowing that you don’t have to do the same workout day after day is motivating by itself.
Have a Plan B: Always have a backup plan that includes other activities you can do in case of inclement weather or other barriers to your planned exercise. For example, if a sudden snowstorm traps you at home on a day you planned to swim laps at the pool, be ready to walk on the treadmill or substitute some resistance activities. You can always distract yourself during your second-choice exercise to make the time pass more pleasantly. Read a book or magazine, watch your favorite TV program, listen to music or a book on tape, or talk with a friend on the phone while you’re working out.
Get an Exercise Buddy (or Several): You don’t need to go it alone when being active. Having a regular (and reliable) exercise buddy increases your likelihood of participating, and it also makes your activities more social and fun. Get your spouse, family members, friends, and co-workers to join in your physical activities, regardless of what time of day you do them. Having a good social network to support your new or renewed exercise habit helps you adhere to it over the long run.
Schedule It: Put your planned exercise down on your calendar or to-do list like you would other appointments. You show up for your doctor appointments, so why should scheduling your physical activity be any different? Never make the mistake of assuming it’ll happen just because you claim that you want to do it a certain number of days per week or month. It takes some planning ahead and the commitment to make it a priority.
Set Goals and Reward Yourself: Setting goals helps keep your interest up. For instance, if you walk for exercise, you may want to get a pedometer and set a goal of adding in 2,000 more steps each day. Break your larger goals into smaller, realistic stepping-stones (such as daily and weekly physical activity goals) for all your active lifestyle changes, and use SMART goals. Trackers, activity logs, and other motivational tools are also widely available online. Tip: Reward yourself when you reach your exercise goals (but preferably not with food).
Get More Spontaneous Physical Activity: You don’t have to work out at a high intensity to help diabetes and weight management. You can also add physical movement all day long doing anything you want to, including gardening, housework, and many other spontaneous physical activities. For instance, if you have a sedentary desk job take the stairs rather than the elevator whenever you can. Walk to someone else’s office or the neighbor’s house to deliver a message instead of relying on the phone or email. Or park your car at the far end of the parking lot and walk the extra distance. Guess what? You’ve just gotten yourself more active without giving it much thought.
Take Small Steps: If you get out of your normal activity routine and are having trouble getting restarted, simply take small steps in that direction. You may need to start back at a lower intensity by using lighter weights, less resistance, or a slower walking speed. Starting out slowly with small steps helps you avoid burnout, muscle soreness, and injury. Even doing only 5 to 10 minutes at a time (rather than 30 or more) is fine. After you’re up and moving, you may feel good enough to exceed the time you planned on doing in the first place. The key is to begin by any means possible.

Get Off the Couch and Work Your Core

plank-fitness-muscular-exercising-163437.jpegIf you suffer from diabetes, you already know that staying fit greatly benefits your health. Yet, many of the complications caused by diabetes can make it difficult to get the exercise you need; in fact, they can make a normal exercise routine difficult or even dangerous. For example, peripheral neuropathy (numbness in the feet caused by nerve damage) may affect your balance and put you at risk for a fall, or could lead to slow-healing ulcers that keep you inactive. On top of that, diabetes patients may have heart disease symptoms or vision problems that make getting up and going for a walk more risky than helpful.

The good news is that these complications don’t have to prevent you from doing safe and healthy exercise. You can still get a beneficial workout—minus the risks—by exercising your core. Even though a lot of people with diabetes think having neuropathy or other complications means they have to be a couch potato, that’s just not true. Just because you can’t get outside for a brisk walk or run doesn’t mean you can’t get fit. Exercising your core is a safe way to improve your strength and stability so you can better handle your daily life—right from your own home.

Core exercises are an important part of a well-rounded fitness program for diabetes patients. Your body core, including the muscles around your trunk, is particularly important to keep strong so you can go about your normal daily activity and prevent falls and injuries, particularly as you age. The best part? They are easy to do on your own in your home, and you don’t even need to purchase any equipment to perform them. However, once you become more advanced, you can accelerate your workouts using a gym ball or dumbbells.

Ready to get a strong core and improve your stability and overall wellness? Here are ten core exercises that I recommend highly for people with diabetes (or anyone for that matter).

Look for illustrated versions of these core exercises in Chapter 21 (“Ten Easy Exercises to Build a Strong Core without Leaving the House”) in Diabetes & Keeping Fit for Dummies by Dr. Sheri Colberg available online at Amazon.com or Dummies.com.

(1) Abdominal Squeezes. This exercise is great for working your abdominals and getting your core as strong as possible. If you’re female and have gone through a pregnancy, getting these muscles in shape doing these squeezes is a must.

  1. Put one of your hands against your upper stomach and the other facing the other direction below your belly button.
  2. Inhale to expand your stomach.
  3. Exhale and try to pull your abdominal muscles halfway toward your spine. This is your starting position.
  4. Contract your abdominal muscles more deeply in toward your spine while counting to two.
  5. Return to the starting position from Step 3 for another count of two.

Work up to doing 100 repetitions per workout session.

(2) Plank or Modified Plank. Nobody likes doing planks, but they get the job done when it comes to boosting the strength of your core. Both planks and modified planks work multiple areas, including your abdominals, lower back, and shoulders.

  1. Start on the floor on your stomach and bend your elbows 90 degrees, resting your weight on your forearms.
  2. Place your elbows directly beneath your shoulders and form a straight line from your head to your feet.
  3. Hold this position as long as you can.

Repeat this exercise as many times as possible during each workout.

(3) Side Planks. A modification of regular planks, this side plank exercise works some of the same and some slightly different muscles that include your abdominals, oblique abdominal muscles, sides of hips, gluteals, and shoulders. Try doing some of both types for the best results.

  1. Start out on the floor on your side with your feet together and one forearm directly below your shoulder.
  2. Contract your core muscles and raise your hips until your body is in a straight line from head to feet.
  3. Hold this position without letting your hips drop for as long as you can.
  4. Repeat Steps 1 through 3 on the other side.

Switch back and forth between sides as many times as you can.

(4) Bridging. If you work on your abdominal strength, you also need to build the strength in your lower back to keep things balanced. Bridging is a good exercise to do that as it works your buttocks (including gluteals), low back, and hip extensors. Remember to breathe in and out throughout this exercise.

  1. Keeping your shoulders on the floor, slowly raise your buttocks from the floor with your stomach tight and your lower back straight.
  2. Gently lower your back to the ground.
  3. Repeat Steps 1 and 2.

(5) Pelvic Tilt. An easy exercise to do, the pelvic tilt works your lower back and lower part of your abdominals.

  1. Lie on your back on the floor with your knees bent and feet flat on the floor.
  2. Place your hands either by your sides or supporting your head.
  3. Tighten your bottom, forcing your lower back flat against the floor, and then relax.
  4. Repeat Steps 2 and 3 as many times as you can.

(6) Superhero Pose. Whether you want to leap tall building with a single bound or not, try doing this superhero pose exercise to get a stronger core. It works many areas, including your lower back, upper back, back of shoulders, and gluteals.

  1. Lie on your stomach with your arms straight out in front of your head on the floor.
  2. Rest your chin on the floor between your arms.
  3. Keeping your arms and legs straight, simultaneously lift your feet and your hands as high off the floor as you can. Aim for at least three inches.
  4. Hold that position (sort of a superhero flying position) for 10 seconds if possible, and then relax your arms and legs back onto the floor.

(7) Knee Push-Ups. Push-ups are hard to do if you haven’t built up the strength in your shoulders yet, so this knee version is an easier way to start for most people. This exercise works your chest, front of shoulders, and back of upper arms.

  1. Get on your hands and knees on the floor or a mat.
  2. Place your hands shoulder-width apart on the floor.
  3. Tighten your abdominal muscles to straighten your lower back and lower yourself down toward the floor as far as you can without touching.
  4. Push yourself back up until your arms are extended, but don’t lock your elbows.

(8) Suitcase Lift. This exercise is the proper way to lift items from the floor. Before you begin, place dumbbells or household items slightly forward and between your feet on the floor. You work the same muscles used in doing squats (lower back and lower body) with this activity.

  1. Stand in an upright position with your back and arms straight, with your hands in front of your abdomen.
  2. Bending only your knees, reach down to pick up the dumbbells.
  3. Grab the dumbbells or items in both hands and then push up with your legs and stand upright, keeping your back straight.

(9) Squats with Knee Squeezes. These squats are not your normal squats. They’re more like a combination of squatting and wall sitting with a twist. You work the front and back of thighs, inner thighs (adductors), hip flexors and extensors all with this one exercise.

  1. Stand with your back against the wall, with your feet aligned with your knees and straight out in front of you.
  2. Place a ball or pillow between your knees and hold it there with your legs.
  3. Inhale to expand your stomach and then exhale and contract your abdominal muscles.
  4. Bend your knees and lower yourself into a squat. To avoid injuring your knees, don’t bend them more than 90 degrees.
  5. Squeeze the ball with your thighs, drawing your stomach muscles more deeply toward your spine.
  6. Do as many squeezes as you can up to 20 and then return to the starting position.

(10) Lunges. Lunges are a common activity to work on the front and back of thighs, hip flexors and extensors, abdominals and lower back all with one exercise. Do them with proper form to avoid aggravating your knees, though.

  1. Keep your upper body straight, with your shoulders back and relaxed and chin up.
  2. Pick a point to stare at in front of you so you don’t keep looking down, and engage your core.
  3. Step forward with one leg, lowering your hips until both knees are bent at about a 90-degree angle. Make sure your front knee is directly above your ankle, not pushed out too far, and don’t let your back knee touch the floor.
  4. Focus on keeping your weight on your heels as you push back up to the starting position.

Even though diabetes sometimes presents tough fitness challenges, you can use these core-strengthening exercises to maintain fitness in spite of any mobility issues you’re facing right now. Whether you still active or sedentary, working your core is a safe and smart way to improve your balance, keep you as fit as possible, and elevate your overall quality of life.

New book on fitness and diabetes

My latest book, Diabetes & Keeping Fit for Dummies, was released this week, just in time to help you start the new year out right. It covers everything you need to know about getting or staying fit with diabetes or prediabetes. Even if you don’t have diabetes and want to improve your insulin action and prevent type 2 diabetes, this book is for you! Check it out today! Available on Amazon.com or Dummies.com.

Are You Getting Enough “SPA” Time?

You’ve probably heard about the recent reports revealing just how dangerous it is to be sedentary. Simply sitting for too long at one time is now a recognized health hazard that everyone should be aware of. But if you suffer from diabetes or prediabetes, a sedentary lifestyle is particularly dangerous. Getting regular exercise and movement is one of the most important things you can do keep your blood glucose under control, maintain a healthy body weight, and reduce your risk of developing complications related to diabetes.

Unfortunately, most people naturally try to do as little physical activity as possible in their day to day lives. How many times have you driven to a store and then circled around the parking lot or waited a long time to find a spot close to the door rather than just parking farther away and walking? When you do that, you’re missing out on a great opportunity for spontaneous physical activity, or SPA.

Spontaneous physical activity or “SPA time” is exactly what it sounds like. It consists of taking a dozen extra steps here and there, which can add up to a lot of calories burned over the course of the day, week, and year. SPA can happen when you get a few more steps by parking farther away or when you stand up or walk around while talking on the phone instead of sitting down. Doing anything—even fidgeting—makes your metabolism work better compared to sitting continuously for long periods of time.

If you have diabetes, adding in more daily movement in any way possible is likely to benefit your life in countless ways. If you get and stay more active every day by doing more SPA, you undoubtedly enhance and maintain your overall health, vitality, and youthful vigor more effectively. Doing easier activities like standing or walking around—even if they don’t make you break a sweat—uses up calories and helps you keep your weight stable.

Here’s one important thing to keep in mind: you won’t get as fit from doing most SPA activities like these, and SPA time alone is not adequate to fulfill your exercise requirements. (You’ll likely need to do both more daily SPA and some cardio, resistance, or other exercise training to keep fit with diabetes or prediabetes. But when matched for number of calories burned, doing easy or moderate spontaneous activities for more total time during the day works as well for improving your blood glucose and your aerobic capacity as doing harder, planned exercise for less time does.

Easy activities like cleaning, washing dishes, grocery shopping, gardening, playing with your kids or grandkids, walking the dog, standing, or any other activity can help lower your blood glucose and keep you more fit and active. Keep reading to learn some easy ways to incorporate more SPA time into your day:

  • Pace or stand while talking on the phone instead of sitting.
  • Always take the stairs instead of the elevator or escalator.
  • Window shop at the nearest mall.
  • Wash your car by hand (and wax it, too).
  • Put on some music and dance.
  • Set up a basketball net in your driveway and shoot some hoops.
  • Walk to a nearby school when school is out of session and use its playground equipment.
  • Hide the remotes for the TV, stereo, and other devices so you have to get up to adjust the settings.
  • Walk in place, dance, move around, or even just stand up while watching TV—at least during the commercials.
  • Limit your TV and home computer use to no more than two hours per day. If you can’t get down to that little, try lowering your current at-home screen time by 30 minutes to start.

Remember, when it comes to better managing your diabetes, all movement counts. SPA time is an easy way to get moving every day, so be sure to keep it going strong as a manageable, and low-impact addition to your fitness routine. Have fun with it, be creative, and above all, enjoy becoming a healthier and more active you.

Musings on Reaching 50 Years with Diabetes

In a break from my usual postings, this one is a stream of consciousness diatribe on my person experiences. Please indulge my musings since I’m nearing the half-century mark of living (well) with type 1 diabetes.

I got diabetes back in the Dark Ages (1968) of its treatment. The only feedback I had on my blood glucose levels was testing my urine, which was several hours behind my actual levels and no reflection on my immediate levels. I never had a number to go with a bright orange (4+) reading of my urine–meaning that I was at the high end of the scale for glucose in my urine–but it did give me a lot of negative reinforcement. It told me that I was “bad” or “not in control” or an unlovable kid–or something along those lines. In other words, it was worthless and only made me feel bad about myself and my diabetes as I grew older. I was convinced that I was going to die from diabetes complications before graduating from high school.

Getting a blood glucose meter when I was in my early 20’s–after 18 years of diabetes without there being any to measure it–was both eye-opening and terrifying. I actually had to go through the emotional stages of dealing with a chronic disease. I realized that I had likely been running in the 200s most of the time (despite taking my insulin as prescribed and following a “diabetes diet”). No more head in the sand! I had diabetes for good and had to deal emotionally with having it. Getting it as young as I did (age of four) and then not having the tools to manage it had effectively allowed me to avoid all of that before.

Once I got a meter, I religiously kept a log of everything affecting me and my blood glucose–food, insulin dosing, exercise, stress, lack of sleep–until I had a handle on how my body reacted to almost everything. In fact, I wrote down everything for over 25 years! Doing that, along with getting a PhD in exercise physiology and teaching nutrition for 19 years at the college level, gave me a greater understanding of how complex our bodily systems are when it comes to keeping blood glucose levels at optimal levels using suboptimal methods (insulin delivery through the skin instead of from the pancreas being the worst barrier of them all). Many of these methodological shortcomings of managing type 1 diabetes are still in play today.

I look forward to meeting the milestone of living for half a century with type 1 diabetes soon and getting my 50-year medals from Joslin and Lilly for doing so. It’s an accomplishment that is worth bragging about–even though I’m fine with living with diabetes at this point in my life. It would be nice to have a cure, but I’m okay with it either way. I live life to the fullest and focus on the important things in life. Because diabetes is largely responsible for teaching me to do that, having it has really been more of a blessing than anything else.

Exercise to Lower Your Risk of Dying (Prematurely) with Type 1 Diabetes

Bob Stewart Jumping (crop)Much of the research on length of life for individuals living with type 1 diabetes is pessimist, which makes a new study released recently a breath of fresh air. Data were collected for the ongoing nationwide, multicenter, Finnish Diabetic Nephropathy (FinnDiane) Study that tracked the death rate of 2,639 study participants for an average of 11.4 ± 3.5 years (1).

In this study, participants’ leisure time physical activity was reported via a self-report questionnaire. Importantly, their physical activity and its intensity, duration, and frequency were examined related to dying from all causes and from cardiovascular events; some of these adults with type 1 diabetes already had diabetic kidney disease.

The researchers also looked at potentially confounding factors like sex, how long people had been diagnosed with type 1 diabetes and how old they were when they got it, as well as physical measures like their systolic blood pressure, triglycerides (blood fats), BMI (body mass index), and HbA1c (a measure of overall blood glucose control over two to three months).

The conclusions of this study came as no surprise to me: exercise is associated with a lower risk of premature death from cardiovascular or any other cause in adults with type 1 diabetes. Overall, 270 people died during the follow-up period, 127 of whom had kidney disease. Only exercise intensity was associated with cardiovascular mortality, with intense activity being best for preventing early death from cardiovascular events. Both how much total physical activity they got and how frequently they exercised were associated with a lower risk of dying from any cause. Prior studies have shown that exercise frequency may also matter in preventing such events, with a higher frequency of physical activity lowering the risk (2).

People with type 2 diabetes have already been shown to have a lower risk of premature death when they are physically active (3); this is also true for the adult population in general (4; 5). However, not as many studies have looked specifically at the association between physical activity and lower mortality risk in adults with type 1 diabetes. Type 1 diabetes has previously been associated with a shorter lifespan in many adults with it, particularly related to endothelial dysfunction and cardiovascular disease (6).

Earlier studies, such as the DCCT, have shown that keeping blood glucose levels in a more normal range can help lower the risk of diabetes-related complications in people with type 1 diabetes. Most deaths in this population are related to either cardiovascular events or kidney failure. Exercise has an innate ability to lower oxidative stress, which has been implicated in the development of many complications, as well as improve endothelial function (6). While regular physical activity is associated with a lower risk of early death in adults with and without type 2 diabetes, this study is one of the first to examine this association in type 1 diabetes.

While the exact amount of exercise needed to lower the risk of cardiovascular events is unknown and not determined by this study, doing any activity is arguably better than remaining sedentary. As in people without diabetes, intense activity likely is even more cardioprotective than moderate or light activity.

However, the exercise in this study was self-reported and only collected at the start of the study, making it is hard to draw definitive conclusions about how much exercise people need to do and how intense it needs to be to reduce the risk of dying.

In conclusion, as confirmed by this latest study, being physically active on a regular basis is critical to living long and well with type 1 diabetes. Remaining sedentary is far worse for your health and your longevity, so go get active!

                                                                                                                                                           

References cited:

  1. Tikkanen-Dolenc H, Waden J, Forsblom C, Harjutsalo V, Thorn LM, Saraheimo M, Elonen N, Tikkanen HO, Groop PH: Physical Activity Reduces Risk of Premature Mortality in Patients With Type 1 Diabetes With and Without Kidney Disease. Diabetes Care 2017;16:dc17-0615
  2. Tikkanen-Dolenc H, Waden J, Forsblom C, Harjutsalo V, Thorn LM, Saraheimo M, Elonen N, Rosengard-Barlund M, Gordin D, Tikkanen HO, Groop PH: Frequent and intensive physical activity reduces risk of cardiovascular events in type 1 diabetes. Diabetologia 2017;60:574-580. doi: 510.1007/s00125-00016-04189-00128. Epub 02016 Dec 00124.
  3. Loprinzi PD, Sng E: The effects of objectively measured sedentary behavior on all-cause mortality in a national sample of adults with diabetes. Prev Med 2016;86:55-57
  4. Biswas A, Oh PI, Faulkner GE, Bajaj RR, Silver MA, Mitchell MS, Alter DA: Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Ann Intern Med 2015;162:123-132
  5. Chau JY, Grunseit AC, Chey T, Stamatakis E, Brown WJ, Matthews CE, Bauman AE, van der Ploeg HP: Daily sitting time and all-cause mortality: a meta-analysis. PLoS One 2013;8:e80000
  6. Bertoluci MC, Ce GV, da Silva AM, Wainstein MV, Boff W, Punales M: Endothelial dysfunction as a predictor of cardiovascular disease in type 1 diabetes. World J Diabetes 2015;6:679-692