Category Archives: Heart Health

When Do You Need a Checkup First Before Starting Exercise?

BP checkHow do you know if you need to get a checkup or medical clearance before you start any exercise training? You should have regular checkups at least annually with your doctor or another healthcare provider if you have any type of diabetes. This helps you keep on top of any problems that may pop up over time that have nothing to do with being physically active.

However, you probably don’t need to see a doctor before you start doing easy workouts or moderate activities like brisk walking. Requiring anyone with diabetes to get medical clearance before starting any type or intensity of exercise is recommended by the American College of Sports Medicine, but is not recommended by the American Diabetes Association because it sets too big of a barrier to participating in regular activities.

On the other hand, having a checkup before you begin more vigorous workouts is a good idea. It also depends on your age, your general health, and your physical activity level. If you’re already doing intense exercise, it’s not necessary, but it is advised for almost everyone with diabetes who is not already exercising at that level—just to be safe.

If/when you do have a checkup, get your blood pressure, heart rate, and body weight measured. If your doctor recommends that you do an exercise stress test, you’ll have to do walking on a treadmill or riding a stationary bike for around ten minutes. Your checkup may also include lab tests (urinalysis, kidney function testing, serum lipid evaluation, and electrolyte analysis) and screening for any diabetes-related complications (including heart, nerve, eye, and kidney disease). Most complications will not keep you from being active, but you may need to take precautions to exercise safely and effectively in certain cases.

For most people, getting a diagnostic graded exercise test is really going too far. Having one is only recommended by the American Diabetes Association if you’re over 40 and have diabetes; or if you’re over 30, have had diabetes for 10 or more years, smoke, have high blood pressure, have high cholesterol, or have eye or kidney problems related to diabetes. If you’re planning to do vigorous training that gets your heart rate up high, these criteria are relevant. If you’re just planning on doing mild or moderate aerobic activity or resistance training, such extensive (and often expensive) testing is unnecessary if you’re reasonably healthy or already fit and don’t have any symptoms of heart or vessel disease.

If you have any pre-existing health complications, you may need to take extra care to prevent problems during exercise. If your blood glucose has been in check, you’ve already been physically active, and you don’t have any serious diabetic complications, then go ahead and keep doing what you’re doing. If you’re very active, getting an extra checkup before you replace your current exercise regime with another exercise routine is neither necessary nor advised.

You still may need to take certain precautions when you exercise, particularly related to getting low blood glucose during and following the activity, going too high, and getting dehydrated. If you have any concerns, check with your healthcare provider at your next visit to discuss any precautions that may be important for your unique health circumstances when exercising.


Exercise: It Does a Body Good!

Athletes around the world are now competing (and competing well) with diabetes. Scott Dunton, a professional surfer with type 1 diabetes, is just one example of how exercise does a body good!

However, there are some things I wish I had always known about exercising with diabetes…

Being active has always made me feel better, physically and emotionally.  But here are some other things about exercise that I wish someone had told me years ago.

1) Exercise can help erase your blood glucose “mistakes”

  • Exercise acts as an extra dose of insulin, figuratively.
  • At rest, insulin is the main way to get glucose into muscle cells, but during exercise, glucose goes muscles without insulin (caused by muscle contractions).
  • Being regularly active makes your muscles more sensitive to insulin, so you will need lower doses of it overall.
  • What better way to help erase a little overeating of carbs (or some insulin resistance) than a moderate dose of exercise to lower your blood glucose?

2) Exercise doesn’t always make your blood glucose go down

  • It doesn’t always make your blood glucose come down, at least not right away.
  • During intense exercise, the glucose-raising hormones your body releases can raise your blood glucose (think high-intensity interval training).
  • Over a longer period of time (2-3 hours), it usually comes back down.
  • If you take insulin, take less than normal to correct a post-workout high or your blood glucose will likely be crashing low a few hours later.
  • A cool-down of less intense exercise (like walking) can help bring it back to normal, though.

3) Your muscle mass is critical to managing blood glucose levels

  • Exercise helps you build and retain your muscle mass, and muscles are the main place you store carbs after you eat them—like a gas tank.
  • Exercising helps use up stored carbs, but can also increase the size of the tank.
  • When you eat carbs post-exercise, they can easily go into storage with a little insulin (or sometimes none at all).
  • Being sedentary keeps the tank full and makes you resistant to insulin.
  • Aging alone can cause you to lose muscle mass over time.
  • Resistance training and/or high-intensity intervals build muscle more, so you need to include these activities regularly as part of your workouts.

4) It’s the best medicine there is

  • Control stress and stave off depression with exercise—and it has no bad side-effects!
  • Exercise is a natural antioxidant—better than supplements!
  • Being active prevents all sorts of cancers, including prostate and breast.
  • It will help you feel better and look younger than you are (and we can all use help with that).
  • You’ll be even less likely to catch a cold, if you exercise moderately.
  • Don’t forget your daily dose of exercise “medicine”
  • Standing more, taking extra steps, and fidgeting help–just be active all day long any way that you can!

Let Your Blood Sugars Rise…?

A study released the first week of February 2008 hit the media headlines hard. “Diabetes Study Partially Halted After Deaths” was the title of the version I read in the NY Times. The introductory paragraph was quite shocking: “For decades, researchers believed that if people with diabetes lowered their blood sugar to normal levels, they would no longer be at high risk of dying from heart disease. But a major federal study of more than 10,000 middle-aged and older people with type 2 diabetes has found that lowering blood sugar actually increased their risk of death, researchers reported Wednesday.” Does that mean we all have to rethink actually trying to control our blood sugars tightly? Continue reading

Fitness, Fatness, and Mortality Rates

For those of you who follow the research, you may remember the debate about whether you can be fat and fit and still well off, as far as your metabolism and disease risk are concerned. Previously, researchers had concluded that although it’s best to be “fit and thin,” being “fit and fat” is almost as good and at least equal to being “unfit and thin.” A new study released in Journal of the American Medical Association a few days ago adds more to the debate when it comes to older adults. Continue reading

Exercise for a Healthy Heart

Did you know that cardiovascular disease (CVD), which includes heart disease, strokes, peripheral vascular disease, hypertension (high blood pressure) and more, was responsible for about 930,000 deaths in the United States last year, or over 38% of all deaths? And people with diabetes have an even greater risk of developing all forms of CVD since elevated blood sugars accelerate the formation of plaque in the coronary arteries that contributes to heart attacks. Continue reading