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diabetesmanagement

What Fitness Professionals Need to Know About Exercise and Diabetes

Are you working with any clients who have type 1 diabetes, type 2 diabetes, or even prediabetes? Well, you have a lot to learn if you don’t know the first thing about those conditions! There are over 100 million Americans currently have diabetes or prediabetes—some of them are, or will be, your clients.

Diabetes is a metabolic disorder that results in elevated levels of blood glucose (“blood sugar”) that can cause many health complications if not managed effectively. Although exercise is one of the three cornerstones of diabetes management, sometimes it can complicate keeping blood glucose levels under control, especially in people who have to replace the insulin that their bodies no longer make (or make enough of). How they respond to being active really depends on the type of exercise and diabetes.

In any case, on a basic level, it’s good to know more about how exercise affects people with diabetes. I have lived well with type 1 diabetes for nearly half a century at this point, and I have always known at some level that exercise did good things for my blood glucose, even before I had my first blood glucose meter (after going 18 years without one).  How could I tell without a meter to test my levels?  Honestly, it was because being active always made me feel better, physically and emotionally.

I earned a PhD in Exercise Physiology to better understand how exercising helped me. You don’t have to go that far with your education, but if you have diabetes or are going to work with clients or patients who have it, here are some basic things that you really need to know.

#1: Exercise can help erase your blood glucose “mistakes”

  • Exercise acts kind of like an extra dose of insulin.
  • At rest, insulin is the main mechanism your body has to get glucose into muscle cells.
  • During exercise, glucose goes your muscles without needing any insulin (via muscle contractions).
  • Being regularly active makes your muscles more sensitive to insulin, so it takes less to have the same blood glucose lowering effect when you eat during or after exercise.
  • What better way to help erase a little overeating of carbs (or some insulin resistance) than a moderate dose of exercise to lower your blood glucose?

#2: Exercise doesn’t always make your blood glucose go down

  • It doesn’t always make your blood glucose come down, at least not right away.
  • During intense exercise, the excess glucose-raising hormones your body releases can raise your blood glucose.
  • Over a longer period of time (2-3 hours), it usually comes back down, but who wants to wait that long?
  • If you take insulin, you’ll need to take less than normal to correct a post-workout high or your blood glucose will likely be crashing low a few hours later.
  • A cool-down of less intense exercise (like walking) can help bring it back to normal, so do an easy, active cool-down after intense workouts or activities.

#3: Your muscles are critical to managing your blood glucose levels

  • Exercise also helps you build and retain your muscle mass.
  • Muscles are the main place you store carbs after you eat them—like a gas tank.
  • Exercising helps use up stored carbs, but can also increase the size of the tank.
  • When you eat carbs post-exercise, they can easily go into storage with a little insulin.
  • Being sedentary keeps the tank full and makes you resistant to insulin.
  • Aging alone can cause you to lose muscle mass over time, but you can combat it to a certain extent by recruiting all of your muscle fibers regularly.
  • Resistance training and/or high-intensity intervals build muscle more because they
    recruit the faster fibers that you don’t use when walking or doing easier activities.

#4: Exercise is the best medicine there is

  • Use exercise to control stress and to stave off depression—with no bad side-effects!
  • It’s a natural antioxidant—more effective and better than supplements!
  • Being regularly active prevents all sorts of cancers.
  • If you’re active, you’ll likely feel better and look younger than you are (as long as you don’t exercise too much).
  • You’ll be even less likely to catch a cold if you exercise moderately and regularly.
  • Standing more, taking extra steps, and fidgeting even help—be active all day long, and don’t forget your daily dose of the best medicine there is!

LEARN MORE: Join Dr. Colberg for her upcoming webinar, Challenges Related to Diet, Nutrition and Exercise in Diabetes


Sheri R. Colberg, PhD, FACSM, is a Professor Emerita of Exercise Science at Old Dominion University and a former Adjunct Professor of Internal Medicine at Eastern Virginia Medical School. She is an internationally recognized authority on diabetes and exercise. As a leading expert on diabetes and exercise, Sheri has put her extensive knowledge to use in founding Diabetes Motion (diabetesmotion.com), a website providing practical guidance about being active with diabetes. She also founded Diabetes Motion Academy (dmacademy.com), offering training and continuing education to fitness professionals.

Diabetes

Type 1 Diabetes Explained

I wrote this post two years ago and still have people with diabetes write to tell me how much it has meant to them. How they printed it off and showed it to their family and friends. How people seemed to finally understand the difficulty of what they live with.

sitting-sedentary

Is Sitting Really the New Smoking?

Make no mistake: sitting less time overall is a good idea for myriad health reasons, but is sitting as bad for you as some would suggest? Is it really the new smoking? In 2017 alone, a slew of new research studies has looked at various health detriments associated with prolonged sitting, even in adults who exercise regularly.

For adults with type 2 diabetes, bouts of either light walking or simple resistance activities benefit not only their glycemic responses to meals (4; 5), but also markers of cardiovascular risk. Both types of interrupting activities are associated with reductions in inflammatory lipids, increases in antioxidant capacity of other lipids, and changes in platelet activation (6).

What is good for one may not be as beneficial for all, though. For example, in adults with low levels of frailty, sedentary time is not predictive of mortality, regardless of physical activity level (1). Sitting more if you are already frail likely just increases frailty and mortality risk, which is not surprising. Along the same lines, being less fit matters in how you respond to breaking up sedentary time. Middle-aged adults with low levels of cardiorespiratory fitness gained the most metabolic benefit from breaking prolonged sitting with regular bouts of light walking, which included five minutes of light walking every 30 minutes over a 7-hour research period (2). If you’re already very fit, adding in some light walking breaks during the day is not going to have as much of an effect—again not surprising.

For in adolescents in school, reducing their sitting time (both in total time and length of bouts) has been shown to improve their blood lipid profiles and cognitive function. A “typical” day (65% of the time spent sitting with two sitting bouts >20 minutes) was compared with a simulated “reduced sitting” day (sitting 50% less with no bouts >20 minutes (3). Can teens stand to improve their health this week? Again, it cannot hurt to break up sedentary time, so why not do it? More recess breaks for teens would be good—and for everyone else for that matter.

All is not lost for people with limited mobility or no ability to engage in weight-bearing activities. Including short bouts of arm ergometry (five minutes of upper body work only every 30 minutes) during prolonged sitting attenuates postprandial glycemia (following two separate meals) when done by obese individuals at high risk of developing type 2 diabetes, even though they remain seated (7). People who cannot walk or stand can, therefore, break up their sedentary time in other ways that can also be metabolically beneficial.

As for other health benefits, breaking up sedentary time is associated with a lower risk of certain types of cancer. In a recent meta-analysis, prolonged television viewing, occupational sitting time, and total sitting time were all associated with increased risks of colorectal cancer in adults (8), which is the most common type after breast/prostate and lung cancers. That study reported a dose-response effect as well, suggesting that both prolonged total sitting time and greater total daily sitting time (2 hours) were associated with a significantly higher risk of colorectal cancer.

In summary, even just the most recent evidence is convincing enough that prolonged sitting is bad for you, and many more studies published similar results in prior years. Is sitting as bad as smoking, though? That remains to be proven. However, you really cannot argue with a recent international consensus statement on sedentary time in older people (9). It states, “Sedentary time is a modifiable determinant of poor health, and in older adults, reducing sedentary time may be an important first step in adopting and maintaining a more active lifestyle.” In fact, the best advice may simply be to consider the whole spectrum of physical activity, from sedentary behavior through to structured exercise (10). Putting yourself anywhere onto that spectrum is definitely better than sitting through the rest of your (shortened) life.

Reprinted with permission from Sheri Colberg.


Sheri R. Colberg, PhD, FACSM, is a Professor Emerita of Exercise Science at Old Dominion University and a former Adjunct Professor of Internal Medicine at Eastern Virginia Medical School. She is an internationally recognized authority on diabetes and exercise. As a leading expert on diabetes and exercise, Sheri has put her extensive knowledge to use in founding Diabetes Motion (diabetesmotion.com), a website providing practical guidance about being active with diabetes. She also founded Diabetes Motion Academy (dmacademy.com), offering training and continuing education to fitness professionals.

 

References cited:

  1. Theou O, Blodgett JM, Godin J, Rockwood K: Association between sedentary time and mortality across levels of frailty. CMAJ 2017;189:E1056-E1064. doi: 1010.1503/cmaj.161034.
  2. McCarthy M, Edwardson CL, Davies MJ, Henson J, Bodicoat DH, Khunti K, Dunstan DW, King JA, Yates T: Fitness Moderates Glycemic Responses to Sitting and Light Activity Breaks. Med Sci Sports Exerc 2017;8:0000000000001338
  3. Penning A, Okely AD, Trost SG, Salmon J, Cliff DP, Batterham M, Howard S, Parrish AM: Acute effects of reducing sitting time in adolescents: a randomized cross-over study. BMC Public Health 2017;17:657. doi: 610.1186/s12889-12017-14660-12886.
  4. Larsen RN, Dempsey PC, Dillon F, Grace M, Kingwell BA, Owen N, Dunstan DW: Does the type of activity “break” from prolonged sitting differentially impact on postprandial blood glucose reductions? An exploratory analysis. Appl Physiol Nutr Metab 2017;42:897-900. doi: 810.1139/apnm-2016-0642. Epub 2017 Mar 1124.
  5. Dempsey PC, Larsen RN, Sethi P, Sacre JW, Straznicky NE, Cohen ND, Cerin E, Lambert GW, Owen N, Kingwell BA, Dunstan DW: Benefits for type 2 diabetes of interrupting prolonged sitting with brief bouts of light walking or simple resistance activities. Diabetes Care 2016;39:964-972
  6. Grace MS, Dempsey PC, Sethi P, Mundra PA, Mellett NA, Weir JM, Owen N, Dunstan DW, Meikle PJ, Kingwell BA: Breaking Up Prolonged Sitting Alters the Postprandial Plasma Lipidomic Profile of Adults With Type 2 Diabetes. J Clin Endocrinol Metab 2017;102:1991-1999. doi: 1910.1210/jc.2016-3926.
  7. McCarthy M, Edwardson CL, Davies MJ, Henson J, Rowlands A, King JA, Bodicoat DH, Khunti K, Yates T: Breaking up sedentary time with seated upper body activity can regulate metabolic health in obese high-risk adults: A randomized crossover trial. Diabetes Obes Metab 2017;23:13016
  8. Ma P, Yao Y, Sun W, Dai S, Zhou C: Daily sedentary time and its association with risk for colorectal cancer in adults: A dose-response meta-analysis of prospective cohort studies. Medicine (Baltimore) 2017;96:e7049. doi: 7010.1097/MD.0000000000007049.
  9. Dogra S, Ashe MC, Biddle SJH, Brown WJ, Buman MP, Chastin S, Gardiner PA, Inoue S, Jefferis BJ, Oka K, Owen N, Sardinha LB, Skelton DA, Sugiyama T, Copeland JL: Sedentary time in older men and women: an international consensus statement and research priorities. Br J Sports Med 2017;19:2016-097209
  10. Dempsey PC, Grace MS, Dunstan DW: Adding exercise or subtracting sitting time for glycaemic control: where do we stand? Diabetologia 2017;60:390-394. doi: 310.1007/s00125-00016-04180-00124. Epub 02016 Dec 00112.
yoga-lake

Stress Management and Diabetes

Diabetes, is left uncontrolled, can cause a whole host of health complications such as vision impairment and neuropathy. It is important to adhere to any instructions your doctor has given you to keep blood sugars controlled. Your physician may also educate you on exercise, diet and stress management to keep a balanced and healthy lifestyle.

Anyone who suffers from chronic stress may have many health issues later in life. One condition that may arise is diabetes.  Prolonged stress can either cause diabetes or make it tough to obtain normal blood sugars. Blood sugar numbers usually go up and down depending on what you do throughout the day. If you are fasting your numbers should be less than 100 but could be 180 two hours after eating a meal. Most diabetics must monitor their glucose levels on a regular basis.

People who have diabetes may also feel stressed because of their treatment plan. This is also called, “Diabetic Distress”.  Individuals with diabetes have many things they must do to take care of themselves such as: check glucose levels, exercise, cook and eat healthy meals, maintain a certain diet and take medications as prescribed. This new lifestyle can be very stressful for many people who have diabetes.

Along with Diabetic Distress there are the usual stressors that are a part of life. It is important to find ways to control stress throughout your lifespan. If you are newly diagnosed, the first step to reducing stress is to talk to your physician. Your medical team is on your side and can help you find a Diabetes Educator. These individuals host classes to go over any new information and questions you may have.

When controlling stress, you need to find out what works for you personally. Some individuals like to take a walk in the park, others choose to practice meditation or use a combination of many techniques. When you start to try new practices remember that you may have to try each a few times. The body has to get used to approaches. A qualified stress management consultant can help you to create a stress management plan specifically for you.

A great way to incorporate stress management into your daily routine is through meditation. Choose a certain time of day that you know will work for you. Some individuals find it helpful to meditate before getting out of bed in the morning. Others find it works best at the end of the day when they have finished working. Taking a break at work during lunch can be helpful as well. Once you find the time of day that works best choose your space. You want to find a room in your house that is free from distraction. It will also help to turn off all electronics and the television.

When practicing meditation, remember that there is no right or wrong way to meditate. Some individuals choose to meditate laying on a mat while others sit or stand. Choose a position that is comfortable for you. When sitting for meditation your knees should be lower than your hips to help sustain the position.

Guided meditation is also a great choice for meditation. A trained instructor will guide you through the meditation to help you reduce stress. Please check out this free guided meditation that you can try at home. Our Soothing Garden meditation may be shared with friends and family as well.


Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 15 years of experience in medical based fitness.

diabetes-exercise-feature

How Exercise May Be the Only Way to Curb the Diabetes Epidemic

The incidence rate of type 2 diabetes has been increasing in the United States for the past 40 years.  In fact, the American Diabetes Association estimates that at least half of all US adults (over 65 million people) have pre-diabetes or full-blown diabetes.  It is often underreported on death certificates, and is probably the third leading cause of premature death in the US.

So why is there such an increase in diabetes in this country?  The biggest reason is diet.

From a young age, children are eating processed food. When they enter school – lunchrooms in many school districts are sponsored with food from McDonald’s, Pizza Hut, and Coca Cola.  In college – most dorm food is also like fast food, and they can eat as much as they want. That and their foray into alcohol, and we have the beginnings of obesity, insulin resistance, and pancreatic damage. The very concept of type 2 diabetes used to be called “adult diabetes”.  Since many teenagers are now diagnosed, it’s now time to change the name.

One would say that if diabetes is a disease of the foods that you eat, then simply change the foods you eat. Not that simple. Once you’re diagnosed with diabetes, you become a ward of the medical system. Doctors will perform a lot of tests, take blood, and prescribe both insulin and drugs to mimic the glucose-lowering effects of the body, and many spend a minimal amount of time counseling on the right type of diet for your needs.

There are, in fact, many good diets to lower blood sugar, like the well-known Keto diet, which emphasizes higher fats and low carbohydrates. This is something that doctors have been prescribing in one form or another since the Atkins diet in the 1960s. What about vegetarian and vegan diets?  If you ask Dr. John McDougall, one of the nation’s leading plant-based doctors, he would advocate that a diet higher in plant-based carbohydrates is better for the body than high amounts of meat and cooking oils.

Both may have a point, but if you look at the food choices that most Americans have, they walk into a grocery store, and if they’re not savvy enough to shop on the outside isles (fruits, vegetables, meats, cheeses), they are trapped in an endless cycle of boxed cereals, candy bars, frozen foods, soft drinks and alcohol. It is almost impossible to go to a store and not pick up about 50-75% of food from a box, bucket or bottle.  Many still haven’t put two and two together — that the foods they eat now will have an effect on their physiology and medical status in 5-20 years.

So what’s missing? I have been in an interesting position of working in diabetes research in the 1980s, and watching from the sidelines the work, research, and policy in this area of medical care for the past 30 years. Here are my thoughts.  

First, although exercise is touted as part of the trilogy of treatment for diabetes (along with diet and insulin), it is the first to be discarded for another type of treatment that is expedient and profitable.  

Second, there are little, if any, referrals to the health club sector in order to work on basic exercise programs for persons with diabetes. Even moderate types of programming will results in dramatic drops in body weight (and fat), daily blood sugars, and A1c levels. It simply is not being done. Many in allied health scream that personal trainers and fitness instructors are not qualified to teach exercise programs for diabetes. With the advent of medical fitness over the past 20 years, this simply isn’t the case today. I would think that having a mechanism to get patients into health clubs through their health plan, or Medicare, or a revolving door policy with their physician group, would be an outstanding way to get more patients into the exercise routine.  

Third, people who work in the fitness industry should be looking very carefully in getting diabetic persons into their facilities in their communities. This takes an effort with health club trainers, club managers and company owners to reach out to the medical community through health programs, lectures, fairs and membership discounts in order to get patients in the door.  It may even entail home exercise visits, or online coaching where patients are taught programs, and keep their exercise routines times and exercise notes. 

Lastly, the fitness industry needs to move into the technology realm and look at the effects of exercise on patients both over 3-4 weeks, but also 3-4 years. This will be done through outcomes-based software programs that can be detailed to physicians, health plans, and sports medicine journals. Once the majority of medical fitness centers and health clubs are on board, we will see a changing of the guard in terms of what Americans think is the best type of treatment program to reduce diabetes symptoms, and look at the data of how people exercise, and how many of their health risks are being reduced by a challenging and consistent exercise program. This can be done at any age, and at almost every state of diabetes — whether they are newly diagnosed, or have basic complications that they are dealing with regarding long-standing diabetes. 

It is time to embrace exercise as part of a diabetes prevention and reduction strategy.  If not, in 20 years we will probably see the epidemic at such a high level, that a good portion of Americans will not be able to work due to their complications.  The costs to society will be even higher than they are now. It’s a risk we don’t need to take, because of the untapped market of over 31,000 health clubs in the US, there is virtually no reason not to engage in exercise. It would seem that our nation’s health depends on our next steps – literally. 


Eric Durak is President of MedHealthFit – a health care education and consulting company in Santa Barbara, CA. A 25 year veteran of the health and fitness industry, he has worked in health clubs, medical research, continuing education, and business development. Among his programs include The Cancer Fit-CARE Program, Exercise Medicine, The Insurance Reimbursement Guide, and Wellness @ Home Series for home care wellness.

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Coronavirus and Type 2 Diabetes

There is plenty of news in the media which says that the COVID-19 is harmless for a healthy individual. They also mention that people with underlying conditions are sensitive to the disease. One such underlying condition that many have is Type 2 Diabetes Mellitus. According to sources, Tom Hanks testing positive for COVID-19 caused panic… that was because this popular actor is also a Type-2 diabetic. 

Why are Diabetic People More in Danger?

A healthy person and a diabetic person are at the same risk of catching the infection. The difference is how the patients deal with the virus. A diabetic patient has a higher chance of facing complications. A person with diabetes will face severe symptoms if they get COVID-19. Diabetes fluctuates the level of glucose in your body. Because of this, diabetic people with COVID-19 have severe inflammation and swelling.

Tips to Protect Diabetic Patients from the Coronavirus

Being a diabetic or the caregiver of such a patient will be stressful for you. Social distancing is the only you can avoid getting the disease. In case you are wondering how to practice social distancing here are a few tips:

  1. Avoid going outdoors, and only do so if it is essential.
  2. Avoid visiting a sick person, whether they are Coronavirus patients or those suffering from any illness.
  3. Try working from home. Discuss this with your employer and try gaining their support in this regard.
  4. Avoid gatherings and large crowds. These include cinemas, restaurants, clubs and bars.
  5. Maintain your blood sugar levels in normal range. That is because people with optimum levels of blood glucose have fewer complications.
  6. Regularly wash your hands. Follow guidelines on the internet about properly washing your hands. If you do not have access, try sanitizing your hands as an alternative.
  7. Avoid hospitals and try contacting your doctor through the phone.
  8. Keep yourself aware of the symptoms of the Coronavirus disease. If you observe any such symptoms, immediately call your general practitioner.

Conclusion

The government suggests shielding advice to all diabetic patients. It meant that all people vulnerable to the disease stay at home for almost 12 weeks. During this period, you should avoid all face-to-face contact. You must understand the risks that you are putting yourself into if you do not take precautions.


Terrance Hutchinson is the Owner of Your Best Lifestyles Fitness and Nutrition. He is a Certified Personal trainer specializing in Exercise Therapy, Corrective Exercise, Sports Nutrition, and Corporate Wellness. He an author of 3 books, he has his own podcast, he has contributed articles to major newspapers and magazines, Terrance has spoken at health events, webinars, seminars, hospitals, schools, doctors offices and has been featured nationally syndicated television platforms. Terrance has clients in many states and counties and is looking to help others bridge the gap between the medical and fitness industries. To learn more about Terrance, visit yourbestlifestyles.com

diabetesmanagement

Pre-diabetes – A Wellness Opportunity To Help

There is an opportunity for wellness and wellness coaching to impact the lives of millions of people in a life-saving way. 79 million Americans are estimated to have a condition called pre-diabetes. Usually symptom free, without intervention they will develop full-fledged Type II diabetes within ten years and possibly endure physical damage to their heart and circulatory system along the way. Yet, according to the American Diabetes Association, if a person is successful at lifestyle improvement they can completely avoid the onset of diabetes 70% of the time.