Exercise and blood sugar regulation -
Vascular and neural complications of diabetes often cause physical limitation and varying levels of disability requiring precautions during exercise, as recommended in Table 5.
Physical activity consideration, precautions, and recommended activities for exercising with health-related complications. Coronary perfusion may actually be enhanced during higher-intensity aerobic or resistance exercise. Onset of chest pain on exertion, but exercise-induced ischemia may be silent in some with diabetes.
Stop exercise immediately should symptoms of myocardial infarction such as chest pain, radiating pain, shortness of breath, and others occur during physical activity and seek medical attention.
Stop exercise immediately if symptoms of a stroke occurring suddenly and often affecting only one side of the body happen during exercise. Lower-extremity resistance training improves functional performance Low- or moderate-intensity walking, arm ergometer, and leg ergometer preferred as aerobic activities Regular aerobic exercise may also prevent the onset or delay the progression of peripheral neuropathy in both type 1 and type 2 diabetes Proper care of the feet is needed to prevent foot ulcers and lower the risk of amputation 6.
Keep feet dry and use appropriate footwear, silica gel or air midsoles, and polyester or blend socks not pure cotton. Manage with appropriate footwear and choice of activities to reduce plantar pressure and ulcer risk Moderate walking is not likely to increase risk of foot ulcers or reulceration with peripheral neuropathy May cause postural hypotension, chronotropic incompetence, delayed gastric emptying, altered thermoregulation, and dehydration during exercise 6.
With postural hypotension, avoid activities with rapid postural or directional changes to avoid fainting or falling.
With cardiac autonomic neuropathy, obtain physician approval and possibly undergo symptom-limited exercise testing before commencing exercise With blunted heart rate response, use heart rate reserve and ratings of perceived exertion to monitor exercise intensity Individuals with mild to moderate nonproliferative changes have limited or no risk for eye damage from physical activity.
With moderate nonproliferative retinopathy, avoid activities that dramatically elevate blood pressure, such as powerlifting. Individuals with unstable diabetic retinopathy are at risk for vitreous hemorrhage and retinal detachment. Avoid activities that dramatically elevate blood pressure, such as vigorous activity of any type.
Avoid vigorous exercise; jumping, jarring, and head-down activities; and breath holding 6. Cataracts do not impact the ability to exercise, only the safety of doing so due to loss of visual acuity.
Exercise does not accelerate progression of kidney disease even though protein excretion acutely increases afterward 6 , Greater participation in moderate-to-vigorous leisure time activity and higher physical activity levels may actually moderate the initiation and progression of diabetic nephropathy — All activities okay, but vigorous exercise should be avoided the day before urine protein tests are performed to prevent false positive readings.
Both aerobic and resistance training improve physical function and quality of life in individuals with kidney disease. All activities okay, but exercise should begin at a low intensity and volume if aerobic capacity and muscle function are substantially reduced.
Doing supervised, moderate aerobic physical activity undertaken during dialysis sessions may be beneficial and increase compliance Exercise should begin at a low intensity and volume if aerobic capacity and muscle function are substantially reduced.
Individuals with diabetes are more prone to structural changes to joints that can limit movement, including shoulder adhesive capsulitis, carpal tunnel syndrome, metatarsal fractures, and neuropathy-related joint disorders Charcot foot In addition to engaging in other activities as able , do regular flexibility training to maintain greater joint range of motion 10 , Stretch within warm-ups or after an activity to increase joint range of motion best Most low- and moderate-intensity activities okay, but more non—weight-bearing or low-impact exercise may be undertaken to reduce stress on joints.
Do range-of-motion activities and light resistance exercise to increase strength of muscles surrounding affected joints. Avoid activities with high risk of joint trauma, such as contact sports and ones with rapid directional changes. Targeted behavior-change strategies should be used to increase physical activity in adults with type 2 diabetes.
For adults with type 2 diabetes, Internet-delivered interventions for physical activity promotion may be used to improve outcomes. Behavioral interventions can significantly increase physical activity in adults with type 2 diabetes , and A1C reductions produced by such interventions have been sustained to 24 months However, motivational interviewing is not significantly better than usual care , and other intervention factors associated with weight loss, such as number and duration of contacts, have been inconsistent or not associated with greater participation Wearing the device may prompt activity, and it provides feedback for self-monitoring.
Pedometer use in adults with type 2 diabetes increased their daily steps by 1,, but did not improve A1C Using a daily steps goal e. The positive findings for pedometers are not universal , however, and some individuals may require greater support to realize benefits.
Longer-term efficacy and determination of which populations can benefit from pedometers and other wearable activity trackers require further evaluation.
Given that the majority of individuals with type 2 diabetes have access to the Internet, technology-based support is appealing for extending clinical intervention reach.
For adults with type 2 diabetes, Internet-delivered physical activity promotion interventions may be more effective than usual care More evidence is needed regarding social media approaches, given the importance of social and peer support in diabetes self-management Physical activity and exercise should be recommended and prescribed to all individuals with diabetes as part of management of glycemic control and overall health.
Specific recommendations and precautions will vary by the type of diabetes, age, activity done, and presence of diabetes-related health complications.
Recommendations should be tailored to meet the specific needs of each individual. In addition to engaging in regular physical activity, all adults should be encouraged to decrease the total amount of daily sedentary time and to break up sitting time with frequent bouts of activity.
Finally, behavior-change strategies can be used to promote the adoption and maintenance of lifetime physical activity. Duality of Interest. No potential conflicts of interest relevant to this article were reported. This position statement was reviewed and approved by the American Diabetes Association Professional Practice Committee in June and ratified by the American Diabetes Association Board of Directors in September Sign In or Create an Account.
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Position Statement October 11 Colberg ; Sheri R. Corresponding author: Sheri R. Colberg, scolberg odu. This Site. Google Scholar. Ronald J. Sigal ; Ronald J. Jane E. Yardley ; Jane E. Michael C.
Riddell ; Michael C. David W. Dunstan ; David W. Paddy C. Dempsey ; Paddy C. Edward S. Horton ; Edward S. Kristin Castorino ; Kristin Castorino. Deborah F. Tate Deborah F.
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B Prolonged sitting should be interrupted with bouts of light activity every 30 min for blood glucose benefits, at least in adults with type 2 diabetes. C The above two recommendations are additional to, and not a replacement for, increased structured exercise and incidental movement.
B Adults with type 2 diabetes should ideally perform both aerobic and resistance exercise training for optimal glycemic and health outcomes. C Children and adolescents with type 2 diabetes should be encouraged to meet the same physical activity goals set for youth in general.
B Insulin users can exercise using either basal-bolus injection regimens or insulin pumps, but there are advantages and disadvantages to both insulin delivery methods.
C Continuous glucose monitoring during physical activity can be used to detect hypoglycemia when used as an adjunct rather than in place of capillary glucose tests. Table 1 Suggested carbohydrate intake or other actions based on blood glucose levels at the start of exercise.
Pre-exercise blood glucose. Carbohydrate intake or other action. Initiate mild-to-moderate exercise and avoid intense exercise until glucose levels decrease.
View Large. Table 2 Suggested initial pre-exercise meal insulin bolus reduction for activity started within 90 min after insulin administration. Exercise intensity. Exercise duration. C Individuals with diabetes or prediabetes are encouraged to increase their total daily incidental nonexercise physical activity to gain additional health benefits.
C To gain more health benefits from physical activity programs, participation in supervised training is recommended over nonsupervised programs.
Table 3 Exercise training recommendations: types of exercise, intensity, duration, frequency, and progression.
Flexibility and Balance. Type of exercise Prolonged, rhythmic activities using large muscle groups e. C Pregnant women with or at risk for gestational diabetes mellitus should be advised to engage in 20—30 min of moderate-intensity exercise on most or all days of the week.
C Exercise-induced hyperglycemia is more common in type 1 diabetes but may be modulated with insulin administration or a lower-intensity aerobic cooldown. C Some medications besides insulin may increase the risks of exercise-related hypoglycemia and doses may need to be adjusted based on exercise training.
C Exercise training should progress appropriately to minimize risk of injury. Table 4 Exercise considerations for diabetes, hypertension, and cholesterol medications and recommended safety and dose adjustments. Exercise considerations.
B Physical activity done with peripheral neuropathy necessitates proper foot care to prevent, detect, and prevent problems early to avoid ulceration and amputation. B The presence of autonomic neuropathy may complicate being active; certain precautions are warranted to prevent problems during activity.
C Vigorous aerobic or resistance exercise; jumping, jarring, head-down activities; and breath holding should be avoided in anyone with severe nonproliferative and unstable proliferative diabetic retinopathy. E Exercise does not accelerate progression of kidney disease and can be undertaken safely, even during dialysis sessions.
C Regular stretching and appropriate progression of activities should be done to manage joint changes and diabetes-related orthopedic limitations. Table 5 Physical activity consideration, precautions, and recommended activities for exercising with health-related complications.
Health complication. All activities okay. Consider exercising in a supervised cardiac rehabilitation program, at least initially. Exertional angina Onset of chest pain on exertion, but exercise-induced ischemia may be silent in some with diabetes.
Hypertension Both aerobic and resistance training may lower resting blood pressure and should be encouraged. Some blood pressure medications can cause exercise-related hypotension.
Ensure adequate hydration during exercise. Avoid Valsalva maneuver during resistance training. Myocardial infarction Stop exercise immediately should symptoms of myocardial infarction such as chest pain, radiating pain, shortness of breath, and others occur during physical activity and seek medical attention.
Restart exercise after myocardial infarction in a supervised cardiac rehabilitation program. Start at a low intensity and progress as able to more moderate activities. Both aerobic and resistance exercise are okay. Stroke Diabetes increases the risk of ischemic stroke.
Restart exercise after stroke in a supervised cardiac rehabilitation program. Congestive heart failure Most common cause is coronary artery disease and frequently follows a myocardial infarction.
Avoid activities that cause an excessive rise in heart rate. Focus more on doing low- or moderate-intensity activities. Peripheral artery disease Lower-extremity resistance training improves functional performance All other activities okay. Consider inclusion of more non—weight-bearing activities, particularly if gait altered.
Local foot deformity Manage with appropriate footwear and choice of activities to reduce plantar pressure and ulcer risk Focus more on non—weight-bearing activities to reduce undue plantar pressures.
Examine feet daily to detect and treat blisters, sores, or ulcers early. Weight-bearing activity should be avoided with unhealed ulcers.
Amputation sites should be properly cared for daily. Avoid jogging. Autonomic neuropathy May cause postural hypotension, chronotropic incompetence, delayed gastric emptying, altered thermoregulation, and dehydration during exercise 6.
Exercise-related hypoglycemia may be harder to treat in those with gastroparesis. With autonomic neuropathy, avoid exercise in hot environments and hydrate well. All activities okay with mild, but annual eye exam should be performed to monitor progression.
Severe nonproliferative and unstable proliferative retinopathy Individuals with unstable diabetic retinopathy are at risk for vitreous hemorrhage and retinal detachment. No exercise should be undertaken during a vitreous hemorrhage. Cataracts Cataracts do not impact the ability to exercise, only the safety of doing so due to loss of visual acuity.
Avoid activities that are more dangerous due to limited vision, such as outdoor cycling. Consider supervision for certain activities. Overt nephropathy Both aerobic and resistance training improve physical function and quality of life in individuals with kidney disease.
Individuals should be encouraged to be active. End-stage renal disease Doing supervised, moderate aerobic physical activity undertaken during dialysis sessions may be beneficial and increase compliance Electrolytes should be monitored when activity done during dialysis sessions.
Strengthen muscles around affected joints with resistance training. Avoid activities that increase plantar pressures with Charcot foot changes. Arthritis Common in lower-extremity joints, particularly in older adults who are overweight or obese.
Participation in regular physical activity is possible and should be encouraged. Moderate activity may improve joint symptoms and alleviate pain.
C For adults with type 2 diabetes, Internet-delivered interventions for physical activity promotion may be used to improve outcomes. Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis.
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The American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Physical activity and exercise during pregnancy and the postpartum period. Adrenaline raises blood glucose levels by stimulating your liver to release glucose.
The food you eat before or during a workout may also contribute to a glucose rise. Eat too many carbs before exercising, and your sweat session may not be enough to keep your blood glucose within your goal range.
Now that you know what causes a blood glucose rise after or during exercise, you may expect and accept it during your next workout session because you know the benefits of exercise outweigh the rise in glucose. Physical activity is important for everyone with diabetes.
Managing glucose levels with any form of exercise is possible once you understand your personal patterns doing regular blood glucose checks and keeping a workout log can help and making adjustments that make sense to you and your lifestyle.
Breadcrumb Home You Can Manage and Thrive with Diabetes Fitness Why Does Exercise Sometimes Raise Blood Glucose? Adrenaline Can Raise Blood Glucose Levels Using your muscles helps burn glucose and improves the way insulin works.
Strategies to Keep Blood Glucose From Rising During Workouts Now that you know what causes a blood glucose rise after or during exercise, you may expect and accept it during your next workout session because you know the benefits of exercise outweigh the rise in glucose.
Practice relaxation techniques such as paced breathing, visualization, or meditation before and during your workout to minimize the adrenaline effect. Consider moving your workout to later in the day if you usually exercise in the early mornings. The dawn phenomenon, a natural rise in blood glucose that occurs between about and a.
The same workout done later in the day is less likely to result in a rise.
This Coenzyme Q absorption how exercise can help regulatipn blood glucose in the short term. And when you are active anv a regular basis, it can also lower your A1C. The effect physical Exercise and blood sugar regulation has regilation your Exercise and blood sugar regulation glucose will Hydration strategies for weight loss depending on reegulation long you are active and many other factors. Physical activity can lower your blood glucose up to 24 hours or more after your workout by making your body more sensitive to insulin. Become familiar with how your blood glucose responds to exercise. Checking your blood glucose level more often before and after exercise can help you see the benefits of activity. You also can use the results of your blood glucose checks to see how your body reacts to different activities. Sheri Rrgulation. ColbergRonald J. SigalJane E. YardleyMichael C. RiddellDavid W. DunstanPaddy C. DempseyEdward S.
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