Physical Activity and Diabetes

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Physical Activity and Diabetes

• Southwest Healthcare
• Physical Therapy Department

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Physical Activity Is Like Magic for Type 2
Diabetes
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What Can Physical Activity Do For You?

• Give you more energy

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What Can Physical Activity Do For You?

• Help you lose weight and keep it off

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What Can Physical Activity Do For You?

• Increase flexibility and strength
• Slow bone loss
• Provide better quality of life

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What Can Physical Activity Do For You?

• Build muscle

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What Can Physical Activity Do For You?

• Improve your sex life

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What Can Physical Activity Do For You?

• Lift your mood
• Treat depression

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What Can Physical Activity Do For You?

• Reduce stress and anxiety

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What Can Physical Activity Do For You?

• Improve blood glucose control
• (lowers A1C)

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Physical activity lowers blood glucose in type 2
diabetes by helping

• muscle cells become more sensitive to insulin
• keep the liver from producing too much glucose
• build more muscle
• you lose weight and keep it off

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What Can Physical Activity Do For You?

• Keep your heart healthy

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Physical activity helps your heart by

• Strengthening heart muscle
• Lowering resting heart rate
• Lowering blood pressure
• Improving cholesterol
• Reducing risk of heart attack and stroke

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Sitting through life increases your risk of

• heart disease
• high blood pressure
• high cholesterol
• overweight
• type 2 diabetes

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We now must plan physical activity into our
schedule
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Getting Started

• Check with your doctor if you
• Are over age 35
• Have had diabetes more than 10 years
• Have high blood pressure, heart disease, poor
  circulation, or other diabetes complications

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Aerobic Activity

• Walking briskly
• Dancing
• Bicycling
• Hiking
• Jogging/running
• Skating
• Stair climbing
• Swimming
• Water exercise

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Resistance Activities

• Push, Pull, and Lift Activities
• increase muscle strength
• prevent falls
• increase mobility
• improve blood glucose control

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Stretching

• Improves your balance and coordination
• Makes you more flexible
• Reduces stiffness
• Reduces your risk of injury

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Stretching

• It is best to stretch your muscles after they are
  warm, that is, after about 10 minutes of easy
  walking, or just following your exercise session.
• Stretching your muscles before exercise can
  result in injury.
• Never bounce or jerk during the stretch ease
  into it slowly just until you can feel it an
  hold for about 30 seconds.

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How Can You Begin?

• Choose activity (example brisk walking)
• Set a long-term goal - at least 30 minutes a day,
  3-5 days a week
• Buy comfortable walking shoes
• Get a partner

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Start Slowly

• Set short-term goal for one week
• Do less than you think you can

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Gradually Increase Activity

• Beginning Exercisers
• First Week - 3 times a week
• Morning Walk 5-10 minutes
• Lunch Walk 5-10 minutes
• After dinner Walk 5-10 minutes

Keep track of how long and how far you walk each
day
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Keep Track of Your Steps

• Use a pedometer
• Keep track of how many steps you normally take in
  a day for one week
• Gradually add 500-1,000 steps a day
• Set a goal of at least 3,000 to
• 4,000 steps more than your baseline

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If Youre Already Exercising Regularly

• Make sure you are exercising at 70 of your
  maximum heart rate.
• Maximum heart rate is 220 your age.
• If you are 40, your max heart rate is 180.
• 70 of 180 is 126, or your target heart rate.

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Interval Training

• To challenge yourself more and really increase
  your metabolism, try interval training.
• Exercise at your target heart rate for 3 minutes,
  then increase your pace to raise your heart rate
  to 80-90 of your max heart rate for 1 minute,
  then slow down and continue at your target heart
  rate.
• Continuing alternating target and 80-90 of max
  for as long as you are able.

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Vary Your Activities
Monday Tuesday Wed Thursday Friday
Walk Swim/ Water Aerobics Walk Swim/ Water Aerobics Walk
Monday Tuesday Wed Thursday Friday
Exercise bike Dance class Exercise Bike Dance Class Exercise Bike
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Reward Yourself

• Use non-food rewards for reaching goals such as
• New book
• Ticket to a play or ballgame
• New clothes or walking shoes
• Bubble bath
• Get-away weekend

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Beginning A Physical Activity Plan

• Type of activities
• List your long-term goal
• List your short term goal
• Barriers
• Rewards

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Effect of Physical Activity on Blood Glucose

• Depends on
• your blood glucose level before you exercise
• diabetes medication
• when and how much you ate last
• your physical fitness
• type of activity

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Effect of Physical Activity on Blood Glucose

• Blood glucose checks before and after exercise
  are the key

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Effect of Physical Activity on Blood Glucose

• Physical activity usually lowers blood
  glucose
• Physical activity can raise your blood glucose
  if
• your BG is gt250 mg/dl before your exercise and
  you have ketones
• youre starting a new vigorous exercise program

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Physical Activity and Low Blood Glucose

• Low blood glucose can result from exercise only
  if you take
• insulin
• oral diabetes medication (pills)
• sulfonylureas (DiaBeta, Amaryl, Glucotrol,
  micronase)
• nateglinide (Starlix) or repaglinide (Prandin)

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What Has Happened to Goofy?

• Goofy takes insulin and is walking briskly in his
  neighborhood in the late afternoon. He becomes
  shaky, is unable to think clearly, and has
  changes in his vision.

What should Goofy do?
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Treatment for Low Blood Glucose

• Equal to about 15 grams of carbohydrate
• ½ cup fruit juice
• ½ cup soft drink (not diet)
• 3 glucose tablets
• 8 Lifesavers

Glucose Tablets
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Physical Activity and Hypoglycemia

• More common after physical activity
• Body is replenishing stored carbohydrate
  (glycogen)

Check your blood glucose after you exercise
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How Can Goofy Prevent Low Blood Glucose Next
Time?

• Adjust Insulin
• For planned, regularly scheduled physical activity

• Eat Snack
• For unplanned physical activity
• When exercising for an extended period of time

Check blood glucose before, during, and after
exercise
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Carbohydrate Snacks for Physical Activity
Intensity Time (minutes) Carbohydrate
Mild Less than 30 May not be needed
Moderate 30-60 15 grams
High Over 60 30-50 grams
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Carbohydrate Snacks for Physical Activity

• Examples of 15 gram carbohydrate snacks
• 6 saltine-type crackers
• 1 cup yogurt
• 2 fig bars
• 1 ounce sport or energy bar
• 8 ounces sports drink - ideally with less than 8
  carbohydrate

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Beware of Too Many Snacks

• Avoid routinely eating extra food if youre
  trying to lose weight
• ask about adjusting your medication dosages
• change the time of day you exercise

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Exercising With Diabetes Complications

• If you have diabetes complications
• An exercise stress test is recommended
• Dont consider diabetes a barrier to exercise
• Most moderate lifestyle activities are safe
• Some activities may need to be modified

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Exercising With Heart Disease

• Caution
• Very strenuous activity
• Heavy lifting or straining
• Exercise in extreme cold or heat

• Choose
• Moderate activity such as walking, swimming,
  biking, gardening
• Moderate lifting, stretching

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Exercising with Hypertension (high blood
pressure)

• Caution
• Very strenuous activity
• Heavy lifting or straining

• Choose
• Moderate activity like
• walking
• weight lifting with light weights
• stretching

Make sure your blood pressure is in control first
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Exercising with Retinopathy (eye disease)

• Caution
• Strenuous exercise
• Heavy lifting and straining
• High-impact aerobics, jogging
• Bending your head below your waist toe touching

• Choose
• Moderate, low-impact activities
• walking
• cycling
• water exercise
• Moderate daily chores that dont require lifting
  or bending your head below your waist

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Exercising with Nephropathy (kidney disease)

• Caution
• Strenuous activity

• Choose
• Light to moderate activity like walking, light
  housework, gardening, water exercise

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Exercising with Neuropathy (nerve disease)

• Caution
• Weight-bearing, high impact, strenuous, or
  prolonged exercise
• jogging/running
• step exercise
• jumping
• exercise in heat/cold

• Choose
• Low impact, moderate activities
• biking
• swimming
• chair exercises
• stretching
• light to moderate daily activities

Check feet after exercise
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Exercise Safely

• Check your blood glucose before and after
  exercise
• Dont exercise if your blood glucose is too high
  or too low
• Carry carbohydrate to treat low blood glucose if
  you are at risk

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Exercise Safely

• Stop exercising if you feel pain, lightheaded, or
  short of breath
• Avoid strenuous activity in extremely hot, humid,
  or cold weather
• Wear proper shoes for the activity to reduce the
  risk of injury

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Exercise Safely

• Wear diabetes identification
• Include warm-up and cool-down sessions
• Drink plenty of fluid

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Words of the Wise...
One step and another step. I am slow but I am
steady. One step, another step. One step and
another. Slow and steady. One step and
another. I can do it! I am slow but I am
steady. And I am the winner !
The Tortoise in The Tortoise and the Hare
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Words of the Unwise...
I can take a little rest.
Zzzzzzzzzzzzzzzzzzzz. The Hare in The
Tortoise and the Hare
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FOOT CARE
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The foot is especially affected by diabetes
because

• Diabetes damages the nerves.
• Diabetes also affects the circulation.
• Diabetes can make the body more prone to
  infection.
• Diabetes can also affect the joints, causing
  stiffness.
• Other diabetes complications can also affect the
  foot, i.e., kidney disease and eye disease.

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As a consequence of these factors a number of
things can go wrong

• The foot may get damaged without you being aware.
• Foot ulcers are common.
• Infections can spread.
• Amputation.
• Charcot foot.

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Charcot Foot
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Grandma used to say

• An ounce of prevention is worth a pound of cure.
• We need to listen to grandma!

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Daily Foot Care

• Wash your feet daily. Use mild soap and lukewarm
  water. Dry very carefully, especially between
  the toes. It often helps to use talcum powder
  to dust the foot to further reduce moisture
  however, be certain to remove all the powder
  between the toes. If the skin is dry, use a good
  emollient BUT not between the toes.

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Daily Foot Care

• Inspect your feet daily. Check for sores, cuts,
  bruises, changes to the toenails use a mirror to
  look under the foot is you cannot see it.
• Cut toenails straight across and never cut into
  the corners use an emery board on sharp corners.
• Do not try to remove corns and calluses yourself
  see a Podiatrist.

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Daily Foot Care

• NEVER use commercial corn cures they can easily
  damage the skin.
• Avoid going barefoot, even in your own home.
• See a Podiatrist at least annually.

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Footwear Tips

• Poorly fitted shoes are a common cause of
  problems in the diabetic foot.
• Have your feet measured each time you buy new
  shoes. The fitter should be experienced in
  dealing with diabetic feet.
• New shoes should be comfortable when purchased
  and should not need a break-in period.

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More Footwear Tips

• The shoes should fit both the length and width of
  the foot, with plenty of room for the toes.
• Avoid shoes with high heels, pointed toes or that
  are tight around the toes.

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Even More Footwear Tips

• Consider fitted orthotics
• A podiatrist can fit you with shoe inserts called
  orthotics to support your feet if you have
  diabetic nerve pain or the muscles have become
  weak from nerve damage.

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Foot and Ankle Exercises
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