Category Archives: Health Benefits

Can Exercise Overcome Impact of Air Pollution on Diabetes Risk?

China air pollutionIt’s known that lack of exercise, poor eating habits, genetics, and lifestyle factors can all contribute to the onset of prediabetes and type 2 diabetes. I have spent many years touting the benefits of lifestyle change to prevent and manage these health conditions—and in some cases reverse them. Exercise is a particularly important lifestyle management tool because of its ability to lower inflammation (the underlying cause of insulin resistance) naturally.

But what being active by itself is not enough to overcome the negative environmental effects? Studies have been coming out for over a decade already examining the association between the onset of type 2 diabetes and persistent organic pollutants (POPs) like those found in pesticides, as well as air pollution emitted by cars and trucks. While we usually think of air pollution as mainly contributing to respiratory problems and lung diseases, there’s mounting evidence that it is also implicated in health conditions like type 2 diabetes.

A recent systematic review and meta-analysis (1) on studies conducted in Europe and North America reported a positive association between air pollution and risk of developing type 2 diabetes. In a recent study (2), air pollution was found to have contributed to 3.2 million new diabetes cases in 2016, or about 14 percent of the total, globally. In the United States, air pollution has been linked to 150,000 new cases of type 2 diabetes each year. Although less evidence has been collected in developing countries where air pollution concentrations are much higher in many of them, long-term exposure to air pollution (including both ambient particulate matter and gaseous pollutants) has been reported to be associated with an increased risk of type 2 diabetes and higher fasting blood glucose levels, especially in individuals who were younger or overweight or obese, in 33 different regions of China (3).

Fresh off another trip to China (and exposure to an excess of smoggy air) where I lectured about the importance of lifestyle management to prevent and manage diabetes, I still find it hard to assess exactly how much of the environmental impact of poor air quality that exercise can overcome. Even though exercise is anti-inflammatory in nature, particulate matter and other toxins in the air are breathed in and lead to inflammation in the body, a state underlies most metabolic diseases, including insulin resistance, obesity, type 2 diabetes, heart disease, and more. Insulin resistance is present long before the onset of type 2 diabetes and results not only from inherited and lifestyle factors but also likely from environmental conditions. Unfortunately, developing countries that are more dependent on the use of coal are at greater risk. One in two people in China already has prediabetes or type 2 diabetes (compared to one in three in the U.S.). Rates of cigarette smoking are higher in China as well, and few, if any, regulations are in place to reduce exposure to second-hand smoke in the cities and even in office settings in many Chinese cities. (The cigarette smoke was heavy in one fitness/recreational area full of treadmills that I recently walked through in a building in Nanjing, China.)

So, then, how much of the inflammatory effect of polluted air can the anti-inflammatory properties of exercise can cancel out? Although we can’t control all the air that we breathe and even if healthy lifestyle habits including a better diet, more physical activity, improved gut health, and a weight loss regimen are not enough to overcome the effects of environmental pollution, it’s still likely that lifestyle improvement can drive down the risk of getting type 2 diabetes or improve your ability to manage it. Just do your best to limit your exposure to particulate matter in the air by exercising indoors on days with worse air quality (regardless of where you live), wearing a mask to limit your exposure to air pollution when outdoors, and avoiding cigarette smoke (both indoors and outdoors) as much as possible.

                                                                                                                                                           

References cited:

  1. Eze IC1, Hemkens LG, Bucher HC, Hoffmann B, Schindler C, Künzli N, Schikowski T, Probst-Hensch NM. Association between ambient air pollution and diabetes mellitus in Europe and North America: systematic review and meta-analysis. Environ Health Perspect. 2015 May;123(5):381-9. doi: 10.1289/ehp.1307823.
  2. Bowe B, Xie Y, Li T, Yan Y, Xian H, Al-Aly Z. The 2016 global and national burden of diabetes mellitus attributable to PM2·5 air pollution. Lancet Planet Health. 2018 Jul;2(7):e301-e312. doi: 10.1016/S2542-5196(18)30140-2.
  3. Yang BY, Qian ZM, Li S, Chen G, et al. Ambient air pollution in relation to diabetes and glucose-homoeostasis markers in China: a cross-sectional study with findings from the 33 Communities Chinese Health Study. Lancet Planet Health. 2018 Feb;2(2):e64-e73. doi: 10.1016/S2542-5196(18)30001-9.
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Why Exercise Does a Body Good

How active are you? Unless you’re exercising more than several hours a day already, you probably have room to add more in for additional health benefits. Exercise is about the best medicine that there is for so many health conditions, including diabetes. Being active helps manage emotional stress and stave off depression—far better than antidepressant medications and with no bad side-effects. It naturally bestows your body with antioxidant effect, making you less likely to develop most types of cancer—or even the common cold.

When it comes to managing diabetes, the benefits are even greater. Many times, exercise can virtually erase your blood glucose mistakes. It acts as an extra dose of insulin by getting the glucose out of your blood and into your muscles without insulin (through an insulin-independent mechanism related to muscle contractions themselves). When you’re not active, your body needs insulin to stimulate that uptake. Being regularly active makes your muscles more sensitive to any insulin in your body as well, so it takes less to get the job done. What better way to help erase a little overeating of carbs (or a slight lack of insulin or insulin resistance) than a moderate dose of exercise?

One thing to know, though, is that exercise doesn’t always make your blood glucose come down, at least not right away. Intense exercise causes a burst of glucose-raising hormones (like adrenaline and glucagon) that raise your blood glucose instead, albeit usually only temporarily. But even if a workout raises it in the short run, over a longer period of time (2-3 hours), the residual effects of the exercise will bring your blood glucose back down while you’re replacing the carbs in your muscles. If you take insulin, take less than normal to correct a post-workout high or your blood glucose can come crashing down later. A cool-down of easy exercise (like less-than-brisk walking) can also help bring it back to normal.

How much muscle you have also matters to blood glucose management. Exercise helps you build and retain your muscle mass, which is the main place you store carbs after you eat them. Almost any type of exercise uses up some of your muscle glycogen, but if you don’t exercise regularly, your muscles remain packed with it. There is a maximal amount that fits in muscles, which is why building up your muscle mass helps with being able to handle the carbs you eat more effectively. Your liver stores some glucose as glycogen, but not much relative to your muscle storage capacity. Being sedentary ensures that no amount of insulin is going to be able to stimulate more blood glucose uptake into your muscles. Without regular exercise to use up glycogen, you really have nowhere to store carbs, so your blood glucose goes up and some of the excess gets turned into body fat instead. Doing resistance or heavier aerobic training is critical to maintaining the muscle mass you have and offsetting the effects of aging on muscles.

People with naturally lower levels of insulin generally live longer (think of centenarians and elite athletes, both with low insulin levels). Exercise helps you keep your insulin needs low, which makes it easier to either make enough of your own or get by with much smaller doses (resulting in less of a margin for big errors in dosing). Plus, it’s a lot harder to lose body fat if your insulin levels are high or you take large doses because insulin promotes fat storage from excess blood glucose. Both the last time you exercised and how regularly you’re active have an impact on the insulin sensitivity of your muscles, so aim to exercise at least every other day (although daily is likely better) and keep all those muscle fibers you have by using them regularly.

If nothing else, start getting more active by standing up more, taking extra steps during the day, fidgeting, and just generally being on the move whenever and wherever possible. Knowing that hopefully takes away your excuses for not being more active. If you can’t get in a planned workout on any given day, you can certainly add in more steps or other activity all day long instead (or do it in addition to your usual exercise). Every bit of movement you do during the day counts, so fidget away as part of your daily dose of exercise!

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.

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.

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

Are My Joint Issues Due to Being Active, Normal Aging, or Diabetes?

Sheri DHHS 30th climbing side viewLiving with diabetes often leads me to wonder if what I’m experiencing—particularly when it’s an irritated joint or an overuse injury—is a consequence of being a regularly physically active person, getting older, or having diabetes, or some combination of those. Which one of these is causing my joint issues? Is it possible to know? I will attempt to answer these questions based on my deeper dive into the published research.

Personally, I have managed to avoid most overuse injuries (such as joint tendinitis) related to physical activity by engaging in cross-training and doing different activities on varying days, and this strategy worked well for me for over 25 years. Of late, though, I have started experiencing chronic overuse injuries (or sometimes just short-term joint irritation) that appear to arise not from most of my usual activities, but more from unusual ones—such as hand-scrubbing my house to get it ready to sell (dominant shoulder joint irritation), tamping down my front yard with a hand compactor (alternate shoulder joint pain that lasted for several years and recurs occasionally), driving a car for several hours in traffic after not driving far often (ankle joint tendinitis of some sort that took months to fully resolve), and random aches and pains in joints that come and go on any given day and may only last a few days at most.

Yes, I’m getting older (aren’t we all?), having successfully passed the half-century mark. I’ve also been living with type 1 diabetes for nearly 50 years (diagnosed at age four in 1968). My A1Cs are in recommended ranges (usually near 6.0%) and have been good ever since I got my first blood glucose meter in 1986 (after going 18 years with nothing but urine testing). I still have blood glucose fluctuations while trying to manage food, exercise, stress, occasional lack of sleep, hormonal variations, illness, and other usual factors that impact my daily levels. So, are my own occasional joint issues the result of being an active person (exercising daily for decades), normal aging, or long-standing diabetes (despite being in relatively good control for the past 30+ years)?

Are overuse injuries more likely to occur due to diabetes or aging? Overuse injuries from participation in athletic endeavors (even just walking) are more common in people with diabetes, likely due to changes in joint structures when exposed to hyperglycemia over time (1). But aging also increases the incidence of overuse injuries when exercisers are older (2). For instance, in one study 70% of the injuries in older exercisers (over 60 years) were overuse injuries, but accounted for only 41% of injuries in younger adults (early 20s).

Is it due to inflammation related to aging or to diabetes? Aging lab rats have overuse activity changes to the structure of their tendons related to inflammation that may make them more prone to injury (3), but when it comes to humans, the research is unclear whether inflammation is involved (4). In one review (5), “prolonged systemic, low-grade inflammation and impaired insulin sensitivity act as a risk factor for a failed healing response after an acute tendon insult and predispose to the development of chronic overuse tendinopathies.” Perhaps, then, in people with diabetes, joint structures do not respond as well to or repair as quickly after activities (6).

Others have argued that low-level, systemic inflammation is not involved in changes to tendons that may lead to injury (4). People with diabetes have some structural joint changes that may or may not be related to diabetes duration or type, although poorer blood glucose management has been associated with higher levels of systemic inflammation (1). Fit, active adults with type 1 diabetes with good blood glucose control exhibit more inflammatory markers in response to exercise, but appear to recover normally (7). If someone has had “good” control for many years, does that lower the chance that their overuse injuries are diabetes-related? I’m quickly raising more questions than I can answer!

Other joint issues like frozen shoulder, carpal tunnel syndrome, and trigger finger are more common in people with diabetes, and structural changes to tendons may occur in people with diabetes (8). On the other hand, my non-diabetic, aging (mid-50s), reasonably active neighbor has had two frozen shoulders in recent years that clearly have nothing to do with diabetes or blood glucose management. I’ve also known people with diabetes who are active that develop a frozen shoulder, but others who get this condition are sedentary, suggesting that such joint issues are not consistently related to diabetes or habitual physical activity.

In short, if you are reading this in hopes of finding out whether joint pains and overuse injuries are more related to being active, aging, or diabetes, you are about to be sorely disappointed because I am unable to determine that based on available research. That said, it is likely that getting older (and not springing back as quickly) contributes to the rise in overuse injuries with aging, but that just means that everyone will have to find ways to be active that do not aggravate any existing issues. The best policy still is to vary your activities, try not to overdo or act like you’re still twenty, and rest appropriately and take time off when necessary to recover from injuries. Given we’re all aging and a significant number of us will be developing diabetes in our later years (if we don’t have it already), it is a topic ripe with possibility for future research.

                                                                                                                                                           

References cited:

  1. Abate M, Schiavone C, Salini V, Andia I: Management of limited joint mobility in diabetic patients. Diabetes Metab Syndr Obes 2013;6:197-207
  2. Kannus P, Niittymaki S, Jarvinen M, Lehto M: Sports injuries in elderly athletes: a three-year prospective, controlled study. Age Ageing 1989;18:263-270.
  3. Kietrys DM, Barr-Gillespie AE, Amin M, Wade CK, Popoff SN, Barbe MF: Aging contributes to inflammation in upper extremity tendons and declines in forelimb agility in a rat model of upper extremity overuse. PLoS One 2012;7:e46954. doi: 46910.41371/journal.pone.0046954.
  4. Kjaer M, Bayer ML, Eliasson P, Heinemeier KM: What is the impact of inflammation on the critical interplay between mechanical signaling and biochemical changes in tendon matrix? 1985) 2013;115:879-883. doi: 810.1152/japplphysiol.00120.02013.
  5. Del Buono A, Battery L, Denaro V, Maccauro G, Maffulli N: Tendinopathy and inflammation: some truths. Int J Immunopathol Pharmacol 2011;24:45-50.
  6. Battery L, Maffulli N: Inflammation in overuse tendon injuries. Sports Med Arthrosc 2011;19:213-217. doi: 210.1097/JSA.1090b1013e31820e31826a31892.
  7. West DJ, Campbell MD, Gonzalez JT, Walker M, Stevenson EJ, Ahmed FW, Wijaya S, Shaw JA, Weaver JU: The inflammation, vascular repair and injury responses to exercise in fit males with and without Type 1 diabetes: an observational study. Cardiovasc Diabetol 2015;14:71
  8. de Jonge S, Rozenberg R, Vieyra B, Stam HJ, Aanstoot HJ, Weinans H, van Schie HT, Praet SF: Achilles tendons in people with type 2 diabetes show mildly compromised structure: an ultrasound tissue characterisation study. Br J Sports Med 2015;49:995-999. doi: 910.1136/bjsports-2014-093696.