Category Archives: Long-Living People with Diabetes

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
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…And Stay Active: My Profile of Success

Sheri exercising pulldown closerI would like to share some of my personal story about why physical activity matters to me and how I have lived successfully with type 1 diabetes for almost 50 years to date. My success with diabetes is undoubtedly related to my decision to be physically active.
The secret to my overall success, both professional and personal, is that I made a conscious choice to live my life by one guiding principle: Live life first, and be diabetic second. In the beginning, I’m not sure it was even a conscious choice (I was only four years old when diagnosed with type 1 diabetes), but rather just an integral part of my personality. I am not one to let obstacles keep me from reaching my goals. Having diabetes has undeniably been one of the greatest challenges to living my life the way I want to, but it has almost never been an insurmountable one.
It’s hard to even imagine life without diabetes when you get it as young as I did. I don’t remember much about being diagnosed other than feeling sluggish and tired all the time. The biggest irony was that my mother had avoided becoming a nurse because she hated needles, but the doctors wouldn’t let me out of the hospital before she learned how to give me shots. She apparently practiced for days shooting water from a syringe into an orange all week. When she gave me my first shot in my arm, she jabbed the needle so hard it rebounded back out. I am told I said, with tears streaming down my face, “Mommy, go practice on the orange some more.”
Diabetes has, in many ways, been a blessing in disguise. It likely had a positive impact on my family’s overall health because our whole family switched to the same diet that was prescribed for me at the time—a balanced diet of carbs, protein, and fat with lots of vegetables, some fruit, and very limited intake of sweets and refined foods. Having diabetes has also been a positive, shaping force in my life when it comes to exercise and physical activity. As such, I have amended my original guiding principle to include, “…and stay active” for that reason: Live life first, be diabetic second, and stay active.
While many people view exercise as a punishment, I fully embrace using diabetes as an excuse to put my workouts first! I started exercising regularly way before it was trendy and known to be good for your health (and blood glucose). I was always active as a kid, playing in the woods, building forts, and just being a tomboy. As a preteen, I began exercising regularly on my own and doing organized sports because being active was the only thing that made me to feel like I had any control over my blood glucose. Way back then no one had blood glucose meters (only inaccurate urine testing), but I could tell being active helped with my blood glucose.
To this day, I still exercise six to seven days a week, and my passion is helping others with all types of diabetes do the same—safely, effectively, and for a lifetime. I vary my daily workouts to keep them fun and to stay injury-free and advise everyone else how to do so. When people ask me how I manage to do all I do, I tell them simply, “I work out.”
Diabetes also led me to an early calling as a healthy lifestyle and diabetes motion expert. When I was about twelve, I spent a week in Kansas with my grandmother, who had what they called “borderline” type 2 diabetes. She was on yet another diet to lose weight, and I decided to help her with dieting while I was there—acting like a personal trainer or fitness coach. I weighed her in every morning, helped her measure out her food (like cottage cheese), and made her jog laps around her backyard. At the start of the week, she agreed to pay me $1 for every pound she lost with my help. She lost eight pounds that week—was I ever a rich kid! Little did I know back then that she likely lost a whole lot less after the first week and gained it all back over time. I just remember her always being about the same body size and shape every time I saw her.
Back then my grandmother was the only other person I knew with diabetes. Later when I was in graduate school working on a degree in exercise physiology, she starting suffering from myriad complications including a heart attack, followed two years later by a major stroke and smaller ones that eventually left her incapacitated. She was bedbound and unable to communicate or feed herself for most her last six years, and she had partial amputations of both of her legs due to chronic ulcers. During one visit, I looked at her and thought, I don’t want to live like that. Consequently, most of my life and career I have focused on how to stay healthy with diabetes and avoid complications. To me, what’s most important is living well while you are alive. That’s why I preach about how important a healthy lifestyle is to maintaining your quality of life (whether you have diabetes or not) and that just living a long time without good health should not be your goal.
You certainly don’t have to get a PhD in exercise physiology like I did to understand the metabolic changes that occur with exercise, but learning why it is so beneficial can be very motivating. You can virtually “erase” overeating mistakes with exercise, and you can keep yourself from getting other health conditions (like heart disease). I’m sure that I am only in excellent health after almost 50 years with type 1 diabetes because of my lifestyle choices—and I want to stay that way until I reach my last day.
As I always say, “What’s the point of living longer if you can’t live well and feel your best every day of your life?” Take my advice and live life first, be diabetic second, and stay as active as you possibly can every day of your healthy (and hopefully long) life.

How to Improve What Really Matters: Quality of Life, Not Longevity

Active senior swimmerFor many years, I have focused on aspects of lifestyle and health management that can enhance quality of life, especially when living with diabetes, rather than simply on living a long time (longevity). Much of my motivation is derived from watching my maternal grandmother suffer through six (long) years of severe disability related to cardiovascular complications of diabetes starting at the age of 70 that left her unable to feed herself or communicate, bed bound, and with almost no quality of life for her final six years. Really, what is the point of simply being alive in that case? This topic has come up again recently. New research published online ahead of print in Diabetologia in Spring 2016 (1) presented results showing that the life expectancy and disability-free life expectancy at age 50 years were 30.2 years and 12.7 good years, respectively, for men with diabetes, and 33.9 years and 13.1 good years for women with diabetes.

Really think about what those estimates mean: If you’re female and have diabetes at age 50, you would be expected to live almost to age 84, but likely be disabled in some way from the age of 71 forward. If the disability is severe (as in the case of my stroked-out grandmother), then that is a lot of pointless years of being alive without really living, not to mention being a huge burden to your family.

Admittedly, that’s pretty discouraging. The best solution may be to focus on what we can do to prevent disability with aging rather than simply living longer. Here are three proven ways to improve your quality of life with diabetes (and likely your longevity):

Exercise regularly and be more physically active overall. Even if you already have some diabetes health issues like peripheral neuropathy, which can negatively impact quality of life, exercising regularly can help. In older adults with diabetes and neuropathy, engaging in just 8 weeks of moderate-intensity aerobic exercise improved their quality of life and led to less pain, more feeling in their feet, less restriction in their activities of daily living, better social interactions, and a greater overall life quality—just after 8 weeks of training (2). Other types of physical activity have similar and profound effects on living well with neuropathy (3), so choose what you enjoy doing the most and start with those.

Eat more fiber, found abundantly naturally in plant-based foods. We all know we should be eating more fiber, but where can you find it (besides in Metamucil, which may not have the same health benefits)? Look for it in plant-based foods, mainly fruits, vegetables, grains, beans, and nuts and seeds. Dietary fiber and whole grains contain a unique blend of bioactive components including resistant starches, vitamins, minerals, phytochemicals, and antioxidants, all of which are critical to healthy living. A higher fiber intake helps prevent or protect against health issues that can decrease both quality of life and longevity, including constipation, hemorrhoids, colon cancer, gastric reflux, obesity, diabetes, stroke, and cardiovascular diseases (4). It also keeps the healthful gut bacteria in your digestive tract more abundant, which directly can benefit health and even prevent obesity. Aim for as much as 50 grams of fiber in your daily diet for optimal health.

Improve the quality and quantity of your sleep. Both sleeping better and sleeping enough (7 to 8 hours a night for most adults) lower insulin resistance and can help improve diabetes control; alternately, not getting enough good sleep can make your blood glucose levels much harder to manage. As you age, it may require taking a melatonin supplement to help you fall asleep and improve diabetes control (5), but exercising regularly certainly assists as well, so try taking your daily dose of exercise to optimize sleep. Get started on these three easy changes today to improve your chances for living longer without disabilities. Remember, there’s more to life than living a long time. What’s the point of living longer if you can’t live well and feel your best every day of your life? It really is your choice to make because you can affect the outcome.

References cited:

  1. Huo L, et al. “Burden of diabetes in Australia: life expectancy and disability-free life expectancy in adults with diabetes” Diabetologia 2016; DOI: 10.1007/s00125-016-3948-x. 2. Dixit S, Maiya A, Shastry B: Effect of aerobic exercise on quality of life in population with diabetic peripheral neuropathy in type 2 diabetes: a single blind, randomized controlled trial. Quality of Life Research 2014;23:1629-1640
  2. Streckmann F, Zopf EM, Lehmann HC, May K, Rizza J, Zimmer P, Gollhofer A, Bloch W, Baumann FT: Exercise intervention studies in patients with peripheral neuropathy: a systematic review. Sports Med 2014;44:1289-1304
  3. Otles S, Ozgoz S: Health effects of dietary fiber. Acta Scientiarum Polonorum Technologia Alimentaria 2014;13:191-202
  4. Grieco CR, Colberg SR, Somma CT, Thompson A, Vinik AI: Melatonin supplementation lowers oxidative stress and improves glycemic control in type 2 diabetes. International Journal of Diabetes Research, 2(3): 45-49, 2013 (doi: 10.5923/j.diabetes.20130203.02)

Secret # 30: Maintain Your Weight

Secret #30 is excerpted from Part Five: Exercise Secrets found in my new book about what has worked well for long-time diabetes survivors: 50 Secrets of the Longest Living People with Diabetes by Sheri Colberg, PhD, and Steven V. Edelman, MD (November 2007). Check my Web site (www.shericolberg.com) for more details or to order this book online.

Excess body weight is associated with a greater risk of many health problems, and even though it may not be the direct cause of all of them, losing body fat or maintaining your body weight are considered important goals, and exercise plays an important role in reaching these goals. Continue reading

Secret # 29: Compete with Yourself

Secret #29 is excerpted from Part Five: Exercise Secrets found in my new book about what has worked well for long-time diabetes survivors: 50 Secrets of the Longest Living People with Diabetes by Sheri Colberg, PhD, and Steven V. Edelman, MD (November 2007). Check my Web site (www.shericolberg.com) for more details or to order this book online.

Until a recent back injury forced him out of the water for a while, Al Lewis, living well with diabetes for over 70 years, was a competitive master’s swimmer, and athletics have played a major role in doing well with diabetes for all those years. Even at the age of 74, he feels it’s important to be very competitive with yourself. Continue reading

Secret # 28: Erase Your Mistakes with Exercise

Secret #28 is excerpted from Part Five: Exercise Secrets found in my new book about what has worked well for long-time diabetes survivors: 50 Secrets of the Longest Living People with Diabetes by Sheri Colberg, PhD, and Steven V. Edelman, MD (November 2007). Check my Web site (www.shericolberg.com) for more details or to order this book online.

Although your muscles account for only about 40 percent of your body weight, they can take up 80 percent of any glucose load that you get through your carb intake. Thus, by enhancing the muscles’ capacity to take up glucose with or without insulin, exercise comes closer than anything else to Continue reading