Diabetes: A weighty issue

Keeping your weight in check goes a long way in managing diabetes. And exercise helps you do it better.

elderly man doing exerciseDiabetes and obesity are so interlinked that experts often put them under the terminology of ‘Diabesity’. Research shows that overweight and obesity is responsible for about 80 per cent of cases of type-2 diabetes. Thus, a targeted approach to weight management can help in reducing risk of developing diabetes and also in a diabetic patient to reduce the number and dose of medicines.

The diabetes-weight connection

As weight increases, certain mechanisms prevent insulin from moving glucose [blood sugar] into cells where it can be used for energy. This is called insulin resistance. Thus glucose does not get transported despite having normal or even high levels of insulin. This becomes the forerunner for development of diabetes. Initially, pancreas overcomes the resistance by producing excess insulin. Over time, the pancreas becomes unable to produce enough insulin to overcome resistance resulting in an abnormal rise in blood sugar.

The ‘stay active’ principle

Being active is an important part of living a healthy lifestyle. This is true for people of all ages and especially true for people with or at risk for diabetes and those who are overweight. The key to weight control is balancing the energy [food] intake with how much energy our body burns [physical activity].

To lose weight, you must burn more calories than you eat. If you eat 100 calories a day more than your body needs, you will gain approximately five kilos in a year. You could lose the excess weight or keep it off by doing 30 minutes of moderate exercise daily.

When Prakash, a diabetic, went for his health check-up he was disappointed as his HbA1c was 9.5 per cent, indicating poor control of diabetes. Prakash was perplexed as he was regularly taking medicines and following an appropriate diet. To his surprise, the doctor diagnosed the main reason to be lack of exercise. Like Prakash, this is one of the biggest dilemmas most diabetics face.

Exercise is one of the four cornerstones of diabetes care [along with diet, medication, and monitoring]. It is not true that people with diabetes taking proper medication need not exercise and people who do regular exercise need not take medicine. All the four tools are essential.

Research by the Diabetes Prevention Program demonstrated that as little as 150 minutes per week of moderate exercise as part of a lifestyle intervention significantly decreased the progression of type-2 diabetes in patients with pre-existing impaired glucose tolerance.

Regular exercise is extremely beneficial to the body because:

  • It makes insulin work better in the body, which helps regulate blood sugar levels.
  • It improves cardiovascular function, increases fitness and physical working capacity and improves sense of well being. The improvement in lipid profile as well as reduction of hypertension is a major effect of exercise on cardiovascular risk factors.
  • It also helps in reducing weight and aids in the loss of visceral fat—quite literally getting to the core of the metabolic syndrome.
  • It helps relieve tension and stress, encourages relaxation, and improves mood.

It’s never too late

It is said that the journey of a thousand miles begins with a single step and exercise works the same way. Taking that first step can be hard, especially if you’ve been diagnosed with diabetes. But, remember—it’s never too late. You can always improve your level of fitness. There’s no need to join a gym or have a personal trainer to make exercise a part of your life.

Even simple things like parking your car further away and walking to your destination or taking the stairs instead of elevators have a huge benefit. Experts recommend about 30 minutes of regular exercise five times a week for maximum benefits.

There are three main types of exercises:

Aerobic exercises. These increase heart rate, work on muscles, and improve breathing rate. Walking, dancing, swimming, and playing various sports are some examples.

Strength training. This, if done several times a week, helps build strong bones and muscles and makes everyday chores like carrying groceries easier for you. With more muscle, you burn more calories, even at rest.

Flexibility exercises. Also called stretching, these help to keep your joints flexible and reduce your chances of injury during other activities. Gentle stretching for 5 – 10 minutes helps your body warm-up and get ready for other activities such as walking or swimming.

Before you start

To gain the benefits of increased physical activity and minimise potential risks, people with diabetes need to understand and evaluate risks and take steps to prevent problems. Here are some rules to follow.

  • Check your blood sugar level before, during and after exercise, especially if you take insulin or medications that can cause low blood sugar. Carry something readily available to eat and drink plenty of fluids while you work out. Stop exercising if you experience signs such as severe shortness of breath, dizziness or chest pain. Hypoglycaemia can occur during exercise or during the next 12 hours that follow and hence it is advised to eat something before you exercise.
  • Check your feet for sores or blisters before and after exercise. Make sure that your workout shoes fit well and are comfortable. Wear soft, absorbent socks. If your feet are already compromised from poor circulation, choose an exercise such as swimming and yoga that will not put undue pressure on them.
  • Carry your diabetes identification card along with you while going outside for exercise.
  • Make sure you drink enough liquid before, during and after your session as dehydration can raise blood sugar.
  • Consult your doctor before starting any exercise regime. This becomes even more important if you have any of these symptoms or conditions:
  • If your blood glucose level over 250 mg/dl
  • If you have any symptoms of cardiovascular problems
  • If you have any evidence of retinopathy [eye problem], neuropathy [brain problem] or nephropathy [kidney problem]
  • Any other ongoing health problems that might limit your ability to exercise.

Although exercise is essential for people with diabetes, but it cannot replace the requirement of diet management, monitoring and medications. Exercise is perhaps the best therapy for prevention of type-2 diabetes.

Thus, our goal for a long and healthy life should include a healthy diet, regular exercise, and maintaining normal weight. Whatever you choose, whichever exercise is right for you, make sure it’s something you enjoy.

Joe George
Joe George, MD, DNB, DM [Endocrinology], is a consultant endocrinologist at Kokilaben Dhirubhai Ambani Hospital, Mumbai.


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