Exercise is an important factor in keeping diabetes under control, but how much and what is recommended? Dr Ali Khalili, consultant, family medicine at Imperial College London Diabetes Centre, Abu Dhabi, advises on the best plan of action.
What is the recommended level of activity for a diabetic patient?
Exercise is known to contribute enormous benefits to health, alongside a balanced diet. The minimum is 150 minutes per week, which includes a combination of both aerobic and resistance exercise. Exercising on alternate days is the minimum requirement to stay healthy, though every day is better, of course. Brisk walking for 30 minutes a day reduces a person’s chances of developing type 2 diabetes, and exercise and a sensible diet can be the best way to minimise the risks and lead a healthy lifestyle.
There is a difference between aerobic and resistance exercise. Aerobic exercise is something that burns fat and is good for your heart health. This is exercise such as fast walking, running, swimming, cycling, or climbing. Resistance exercise is something that you do to build muscle. Both forms of exercise are good for diabetic patients and for burning fat efficiently.
Are there any exercises that are dangerous for people with diabetes?
There are two different types of diabetes and we must distinguish them first. Type 1 diabetes is completely insulin-deficient diabetes, whereas type 2 occurs when the body can no longer utilise insulin properly. Obesity is widely regarded as the number one risk factor for type 2 diabetes, as extra body weight means a higher risk of insulin resistance because fat interferes with the body’s ability to use insulin.
There are different stages of type 2 diabetes. Patients who have just been diagnosed with type 2 diabetes and are only on light medication to control their sugar levels can exercise normally. We advise them to make an appointment with a doctor to make sure their heart is in good condition and they don’t have any other complications. We then recommend they start their exercise regime lightly and increase it gradually so no major strain is put on the heart. After about two to three months, these patients can start resistance exercise at the gym.
During the late stage of the condition, many patients have related complications, so they must be extremely careful when exercising. We strongly advise them to obtain their doctor’s approval before beginning any exercise regime. Their doctor will be able to assess their condition and ensure their heart can handle the level of activity they want to pursue. These patients may also have neuropathy [numbness in their hands and feet] that can cause them to fall and injure themselves if they are running. They are much better off on the stationary bicycle instead, where the feet are stable.
Type 1 diabetics are very different because they are insulin dependent and rigorous exercise can be quite dangerous. If their sugar levels drop to less than 150 mg/dl they may have a hypoglycaemic episode, so these patients may need to take a glucose supplement or a sugar snack while exercising to make sure this doesn’t happen.
Some patients believe that by exercising they will burn off their sugar and therefore do not administer their normal insulin dose. This, in fact, has the opposite effect: exercising may cause their sugar levels to actually increase, which can turn into a serious condition called diabetic ketoacidosis.
It is important that patients monitor their sugars carefully before they start exercising so that levels of less than 150 mg/dl or more than 250 mg/dl are appropriately managed before starting exercise.
Do diabetic patients need to exercise every day?
For patients with type 1 diabetes, exercise will mostly be to maintain good heart health.
Type 2 is very different. These patients are insulin resistant, which means their body’s cells [for example fat and muscle cells], are resistant to the insulin they are producing. One of the best ways to correct this resistance is through exercise, because it enables the cells to take in the sugars that they need. Exercise is very important for type 2 diabetes patients, and in some ways it is also a treatment and even a cure for early impaired glucose [a state where your blood sugar is raised beyond the normal range, but is not so high that you have diabetes].
Brisk walking for 30 minutes a day reduces a person’s chances of developing type 2 diabetes, and exercise and a sensible diet can be the best way to minimise the risks.
What kind of pre- and post-workout foods are recommended for diabetic patients?
Most type 2 diabetics can eat typical foods that non-diabetes patients eat before their workout. What I usually recommend is 30 to 50 grams of carbohydrates a couple of hours before the workout. After the workout, they will again need about 15g to 30g of carbohydrates and some protein, the amount of which depends on the intensity of the workout.
The protein intake depends on your body size, but we usually recommend 0.8g to 1g per kilogram of body weight. That will need to be increased to 1.5g per kilogram after a tough workout. This is usually 30g to 40g of extra protein. Sources of protein include whey protein powder, chicken breast and a 170g to 230g steak.
Patients with type 1 diabetes will need to have a proper exercise schedule so they know when they are going to work out and plan to adjust their carb intake and insulin administration accordingly to prevent hypoglycaemic episodes.
What activities count as moderate exercise?
Moderate exercise can include fast walking or running, swimming, leisurely cycling and certain amount of active gardening [such as lifting flower pots].
What are some recommended gym activities for diabetic patients?
This depends on the type of diabetes and how far it has progressed. Our advice is to see the doctor initially and take any information your doctor gives you to the trainer at the gym and let them develop a programme.
I would recommend starting with a trainer and not to do it on your own. This is because patients may injure themselves if they start with a very intense regime. Having a trainer with you will help avoid any mistakes and prevent you from injuring yourself.
If a personal trainer is not an option, then I would suggest starting off very lightly, such as on the cycling machine. The cross-trainer is good, too, but you get tired very quickly. I would definitely not recommend high-impact aerobic exercises like Zumba unless you’re experienced and have built muscle over three to four months.
Yoga and Pilates are extremely good exercises to start with and will rarely cause you any problems. They are good for your breathing and provide a low-level resistance exercise and a good level of aerobic exercise.
Exercise is absolutely vital, but do it with caution and make sure you initially see your doctor to ensure you don’t have cardiac, neurological or kidney problems.