Whether you’re new to exercise or a sports enthusiast, diabetes can get in the way of being physically active. To deal with this problem, I founded a new information web site called Diabetes Motion (www.diabetesmotion.com), given that I’m one of the world’s leading experts on diabetes and exercise. The mission of Diabetes Motion is to provide practical guidance about blood glucose management to anyone who wants to be physically active with diabetes.
Without a doubt, being physically active is good for the body, heart, and mind. If you are already an avid exerciser, then you know the benefits of exercise for your health and diabetes control. If you are just thinking about getting serious about sports or fitness activities, then you have a lot of positive changes to look forward to.
Exercise can help you build muscle and lose body fat, suppress your appetite, eat more without gaining fat weight, enhance your mood, reduce stress and anxiety, increase your energy, bolster your immune system, keep your joints and muscles more flexible, and improve the quality of your life. For many people with diabetes, being physically active has made all the difference between controlling diabetes or letting it control them.
What you may not know is what type of exercise or physical activity you should you be doing or how much of it is recommended for optimal health and the best blood glucose control. The good news is that you can get different (but all good) benefits from doing a variety of types of daily movement, which gives you a lot of options. In fact, exercising regularly is likely the single most important thing you can do to slow the aging process, manage your blood sugars, and reduce your risk of diabetic complications.
Need help with revving up your exercise? If your exercise performance been less than you’d hoped recently, here are some potential causes of fatigue (and solutions):
Inadequate rest time: You may be getting through your workouts well, but then fail to perform when you have races and events simply because you didn’t take enough rest time to restore glycogen and fully recover. It’s critical to cut back on your workouts (“taper”) for at least 1-2 days before a big event and keep your blood glucose in good control so your glycogen levels will be as full as possible on race/event day.
Blood glucose and glycogen stores: It’s harder for your body to restore your muscle glycogen (stored carbs) between workouts unless you’re eating enough carbs and have functioning insulin available. Your carb intake doesn’t have to be tremendous—probably just 40% of your total calories coming from carbs will suffice—but your blood glucose absolutely needs to be in good control for your muscles to restore carbs optimally.
Iron: Having low iron stores can cause you to feel tired all the time, colder than normal, and just generally lackluster. You can get a simple blood test done to check your hemoglobin (iron in red blood cells) and your overall iron status (serum ferritins). If your body’s iron levels are low (due to diabetes or non-diabetes causes), taking iron supplements can help, along with eating more red meat with lots of absorbable iron.
Magnesium: You may have a magnesium deficiency, especially if you take insulin or your blood glucose levels are not optimal. Magnesium is involved in over 300 metabolic pathways. If you’re deficient, your exercise will be compromised and you may even experience some muscle cramping. To correct a deficiency, eat more foods with magnesium in them—such as nuts and seeds, dark leafy greens, legumes, oats, fish, and even dark chocolate—but taking a supplement may also help.
B vitamins: For people with diabetes, thiamin (vitamin B1) deficiency is also a likely culprit in exercisers and can be further depleted by alcohol intake. People who take metformin to control diabetes can also end up deficient in vitamins B6 and B12, both of which are essential to exercising well. Consider taking a vitamin B complex daily.
Thyroid issues: Having lower levels of functioning thyroid hormones can cause fatigue and poor exercise performance. Have your main thyroid hormones (TSH, T3 and T4), but possibly also your thyroid antibodies if your thyroid hormones levels are normal and nothing else is helping your exercise (specifically antibodies to thyroid peroxidase), especially if you have celiac disease.
Still stumped? If you’ve been through this list and had everything check out okay, then consider other possible issues like your hydration status, daily carb intake (adding even just 50 grams per day to your diet may help), other possible vitamin and mineral deficiencies (vitamin D, potassium, etc.), statin use (some statins taken to lower blood cholesterol cause unexplained muscle fatigue), and frequent hypoglycemia.
Please visit www.diabetesmotion.com for more helpful information about being active with diabetes.
A lot of people with type 2 diabetes delay going on insulin for as long as possible because they’ve heard horror stories about how much weight it can make them gain (or maybe they just don’t like shots), but people with type 1 don’t have a choice. While it is true that insulin treatment is often associated with weight gain and more frequent bouts of hypoglycemia (low blood sugar), the real question is, why?
Some theories to explain insulin-induced weight gain are that when using insulin, your blood sugar is (usually) better controlled and you stop losing some of your calories (as glucose in your urine when your blood sugars exceed your urinary threshold) and that you may gain weight from having to eat extra to treat any low blood sugars caused by insulin. If you’re taking oral medications to lower your blood sugar and they are not working, however, insulin may be your main option for better control.
A few research studies have looked at whether weight gain is simply a result of eating more when you’re on insulin. One such study found that weight gain was not due to an increase in food intake, but rather that your body may increase its efficiency in using glucose and other fuels when your glycemic control improves—making you store more available energy from the foods you eat as fat (even if you’re eating the same amount as before you went on insulin) (1).
So, what can you do to avoid weight gain if you have to take insulin? First of all, you should try to keep your insulin doses as low as possible because the more insulin you take, the greater your potential for weight gain is. The best way to keep your insulin needs in check is to engage in regular physical activity. By way of example, some people with type 2 diabetes who were studied gained weight from insulin use while others did not. Interestingly, the main difference between the “gainers” and the “non-gainers” was that the gainers were less physically active (2). Moreover, in people with type 1 diabetes, taking insulin doses that effectively manage blood sugars can also lead to weight gain, but increases in activity levels have been shown to prevent getting fatter (3).
During any physical activity, your muscles can take up blood glucose and use it as a fuel without insulin and then following exercise, your insulin action is heightened for a few hours and as long as 72 hours—meaning that you will need smaller doses of insulin to have the same glucose-lowering effect. It is my personal experience that regular exercise is the best way to prevent insulin-induced weight gain, but your insulin doses will also need to be adjusted downward to prevent low blood sugars that cause you to take in extra calories to treat them.
Second, you may be able to avoid weight gain by taking a look at the type of insulin(s) that you are using. For example, in overweight type 2 diabetic subjects, use of once-daily Levemir (detemir) caused less weight gain and less frequent hypoglycemia than use of NPH (4), even combined with use of rapid-acting injections of a separate insulin for meals (and the same is likely true when using Lantus, or insulin glargine). Anyone taking basal insulin alone (once or twice daily) or following a basal-bolus regimen can benefit by making sure that insulin doses are regulated effectively to prevent blood sugar lows and highs—while using as little insulin as absolutely necessary to get the desired glycemic effect.
In other words, the type of insulin you use and the doses you take are both important to consider in the overall management of your diabetes and your body weight, regardless of which type you have. Just as importantly, though, is how you choose to manage your lifestyle, both your exercise and your dietary choices. Changes in your lifestyle, such as cutting back on refined carbohydrates that require larger doses of insulin to cover them and exercising regularly, are likely your best bets to counteract any potential weight gain caused by insulin use. An added side benefit is that if you have type 2 diabetes and start exercising regularly, you may actually lose fat weight and be able to lower your insulin doses more or get off of insulin injections completely.
- Jacob AN et al. Weight gain in type 2 diabetes mellitus. Diabetes Obes Metab. 2007 May;9(3):386-93.
- Jansen HJ et al. Pronounced weight gain in insulin-treated patients with type 2 diabetes mellitus is associated with an unfavourable cardiometabolic risk profile. Neth J Med. 2010 Nov;68(11):359-66.
- Jacob AN et al. Potential causes of weight gain in type 1 diabetes mellitus. Diabetes Obes Metab. 2006 Jul;8(4):404-11.
- Fajardo Montañana C et al. Less weight gain and hypoglycaemia with once-daily insulin detemir than NPH insulin in intensification of insulin therapy in overweight Type 2 diabetes patients: the PREDICTIVE BMI clinical trial. Diabet Med. 2008 Aug;25(8):916-23.
The latest statistics about diabetes released by the Centers for Disease Control and Prevention are staggering: 25.8 million Americans have diabetes, and another 79 million with prediabetes are waiting in the wings to develop it. This rise in cases is exponentially greater than what was predicted even a decade ago, and the increase in diabetes a worldwide trend, not just a North American one. At current rates, everyone around the globe will have diabetes or prediabetes before the end of this century.
People are quick to point their fingers at weight gain, fast food gluttony, and slothful lifestyles as being the main culprits, but what if it’s more than that? Is there anything that can be done to abate this looming health crisis? In his recent book, Diabetes Rising, author and journalist Dan Hurley examines five potential reasons behind what has become a modern pandemic. At this point, his five hypotheses—revolving around weight gain, cow’s milk, persistent organic pollutants (POP), vitamin D, and hygiene—warrant further discussion.
The first is the Accelerator Hypothesis, which revolves around body weight and insulin resistance. Some researchers are actually beginning to believe that type 1 and type 2 diabetes–heretofore considered to be caused by autoimmune destruction of insulin-producing beta cells and a high level of insulin resistance, respectively–may actually be the same disease. He postulates that the recent rise in cases of both types of diabetes have been accelerated by weight gain (an environmental factor), but are modulated by genetic factors, including the tendency to have a highly reactive immune system and the tendency to develop insulin resistance in response to weight gain. The jury is still out on whether weight gain is a direct casual factor, but we do know that type 2 diabetes risk can be lowered greatly by even a small (5-7%) decrease in body weight.
The Cow’s Milk Hypothesis relates more directly to the development of type 1 diabetes and could more accurately be called the Foreign Protein one. In essence, early exposure in infancy to any proteins other than the ones found in human breast milk appears to make the body’s immune system more permissive toward autoimmunity and the ultimate destruction of the insulin-producing beta cells in the pancreas. An easy (and economical) approach is to promote the breast feeding of all infants as long as possible during the first year of life.
Hurley’s discussion of the risks associated with organic pollutants in the POP Hypothesis is quite compelling and is picking up steam. POPs originate from pesticides, but also from solvents, pharmaceuticals, paints, pollution, and even plastic. These compounds accumulate in body fat, so levels are higher farther up the food chain. One study actually showed a 38-fold increase in diabetes incidence when comparing the lowest and highest quartiles of POP exposure, and a follow-up study suggested that obesity leads to diabetes only when a person has POPs above a certain level—which are stored in body fat. In that case, keeping body fat lower may actually be quite effective in lowering diabetes risk by decreasing the amount of POPs stored in the body.
The Sunshine Hypothesis is not a new one where type 1 diabetes is concerned as it was noted several decades ago that its incidence is higher at northern latitudes compared to southern ones. However, the role of the sun (and vitamin D) in type 2 diabetes development (and even in prediabetes) is a more recent hypothesis. Most vitamin D is manufactured in the body following exposure to sunlight, and the rise in diabetes parallels greater use of sunscreen and less time spent outdoors. The evidence is compelling enough that recommended vitamin D intakes were recently raised for the population as a whole, based on age: 600 International Units (IU) daily for children and adults up to 70 years old, 800 IU a day for ages 71 and older.
Finally, the Hygiene Hypothesis suggests that making our environments too sterile may actually be increasing our risk of developing diabetes. In fact, people living in lesser developed regions around the world have a lower incidence of type 1 diabetes, allergies, and asthma. Exposure to some bacteria and other germs appears to strengthen the immune system and keep it less likely to start attacking parts of the body.
While these theories are interesting, what we really need to know is how to reverse the potential tsunami of diabetes cases while there is still time. Hurley postulates on “curing” diabetes with an artificial pancreas and with bariatric surgery, but neither of these solutions is really a cure, nor is either feasible on a worldwide scale.
At this point in time, the ultimate key to ending the diabetes pandemic is prevention, and that “cure” is only going to come through united action to make living healthier. Collectively, we are going to have to make personal choices to eat healthier foods and demand access to healthier (and less caloric) fare; make physical movement a requirement rather than an option (in schools and in the workplace); find government-directed ways to reduce our exposure to environmental pollutants of all types; stop oversterilizing our personal environments; and spend a little more time in the sun without overdoing the sunscreen. Furthermore, it’s likely going to take community uprisings and the use of political clout to change some of the policies in place. Time to get busy!
ACSM, American Diabetes Association guidelines make strong case for physical activity
INDIANAPOLIS – New guidelines on exercise for people with diabetes are likely to open some eyes—and, for those who follow them, help prevent or manage diabetes, improve overall health and boost quality of life. A panel of nine experts developed the recommendations, published this month in Medicine & Science in Sports & Exercise®, the official journal of the American College of Sports Medicine (ACSM). ACSM and the American Diabetes Association issued the guidelines as a Joint Position Statement.
While research has solidly established the importance of physical activity to health for all individuals, the new guidelines provide specific advice for those whose diabetes may limit vigorous exercise. The recommendations call for at least 150 minutes a week of moderate-to-vigorous aerobic exercise spread out at least three days during the week, with no more than two consecutive days between bouts of aerobic activity. “Most people with type 2 diabetes do not have sufficient aerobic capacity to undertake sustained vigorous activity for that weekly duration, and they may have orthopedic or other health limitations,” says Sheri R. Colberg, Ph.D., FACSM, who chaired the writing group. Hence, she explains, the group calls for a regimen of moderate-to-vigorous activity and makes no recommendation for a lesser amount of vigorous activity.
Strength training, too
Aerobic activity alone cannot give full benefit of exercise to diabetic individuals, say the experts. Recent research has shown that resistance exercise (strength training) is as important as—and perhaps even more important than—aerobic training in diabetes management. The latest studies, says Colberg, have reinforced the additional benefit of combining aerobic and resistance training for people with diabetes.
No excuses: Physicians should prescribe exercise
According to Colberg, “Many physicians appear unwilling or cautious about prescribing exercise to individuals with type 2 diabetes for a variety of reasons, such as excessive body weight or the presence of health-related complications. However, the majority of people with type 2 diabetes can exercise safely, as long as certain precautions are taken. The presence of diabetes complications should not be used as an excuse to avoid participation in physical activity.” In keeping with the philosophy of ACSM’s Exercise is Medicine® initiative, Colberg urges that physical activity be a conscious part of every person’s health plan, as appropriate for age and physical condition.
High stakes, high yield
The benefits far exceed considerations of an individual’s health and quality of life, say Colberg and other experts. Predictions that one in three Americans will have diabetes by 2050 (Centers for Disease Control and Prevention) are accompanied by estimates that diabetes and prediabetes in the U.S. will cost almost $500 billion a year by 2020 (UnitedHealth Group, Inc.). According to Colberg, “If current trends go unabated, we are in fact doomed to higher health care costs and drastically reduced quality and length of life due to diabetes-related complications such as heart disease and kidney failure. As individuals, as communities and as part of a nation and world, we have to work collectively to stop diabetes before it stops us.”
November 14 is World Diabetes Day! It was introduced in 1991 by the International Diabetes Federation (IDF) and the World Health Organization (WHO) in response to the alarming rise in diabetes around the world. In 2007, Continue reading
For any of you interested in hearing Dr. Sheri talk about exercise, diabetes, her books, and more, tune in to http://www.wvlt.com streaming on the Web to listen live on Tuesday, February 17, 2009, at 8:00-9:00 PM Eastern time. If you miss her live, but want to hear it later, tune in to hear the archived podcast on http://www.diabeteslivingtoday, a great source for other diabetes information as well.