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Is it safe to exercise if you have diabetes? What are the dos and don’ts?

Exercise can get tricky if you’re diagnosed with diabetes mellitus, which includes both Type 1 and 2 diabetes, and you have to watch your blood sugar or glucose level during your jog or session in the gym.

If your blood glucose level drops too low, you risk developing hypoglycaemia, which can bring on signs such as shakiness, lightheadedness, an irregular heart beat and headache – not good if you’re out brisk walking and you faint.

Go too high and you could develop hyperglycaemia – a very real concern for many with the more common Type 2 diabetes. The main symptoms of hyperglycaemia include increased thirst, hunger and urination. If left untreated, the consequences can be dire and can result in a diabetic coma and damage to organs such as the eyes, kidneys, nerves and heart.

It is enough to overwhelm those living with diabetes when all they want to do is take a walk in the park or roll out a mat for yoga. And we haven’t even factored in the fatigue, low energy and other health conditions that many such patients experience.

But exercise can be key to helping you better manage your blood glucose level, hit that Goldilocks sweet spot – and even reduce your reliance on insulin treatment, said experts.

BUT HOW DO I EVEN CONVINCE MYSELF TO BEGIN EXERCISING?

Many people living with diabetes may also have other health conditions such as joint pain, heart disease, kidney disease, weight issues or poor vision that pose considerable barriers to exercise, said Prof Tai.

They may also be older and have been sedentary, so they may not know how to go about starting a fitness routine. Then, there’s the psychological hurdle to consider as well. “Motivation is the hardest part. Some people just hate the idea of exercise,” said Prof Tai.

But convincing these exercise-adverse individuals to lift a dumbbell can happen. It starts by helping them realise they have this emotional response to exercise and explore why they have this response, said Prof Tai. “Then, we help them find ways to overcome this initial emotional response, so that they can think about why they do this.”

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In most cases, the motivation to exercise isn’t merely to improve health, said Prof Tai. “I don’t talk to my patients about exercise or physical activity to treat or prevent diabetes. I ask them to think about what they want to be able to do (for example, climb a flight of stairs to cross an overhead bridge, or lift a 7kg suitcase into an overhead compartment in the plane) and work towards that goal.”

DON’T PHYSICAL ACTIVITIES SUCH AS STAIR CLIMBING AND HOUSEHOLD CHORES COUNT AS EXERCISE?

The American Diabetes Association recommends that people with diabetes get at least 150 minutes of moderate-intensity exercise weekly. The good news is, yes, you can count physical activities such as taking the stairs and walking to dabao (buy takeawaychicken rice as part of this quota, said Cheryl.

“As long as they are activities that work the large muscles, increase heart rate and make you respirate harder – almost any form of physical activity is beneficial,” she said.

What about making the entire quota of 150 minutes per week all about physical activities? While you may break into a sweat from changing the bed sheets, it’s not high enough of an intensity to match that of resistance training with weights, or aerobic exercises such as running, swimming and cycling, said Chermine.

It’s akin to boiling water. When you turn up the heat, the water boils faster. Similarly, when you perform an activity at a higher intensity, you increase your body’s demand for glucose.

Scenario 1: I’m not sure what I should take note of

Monitor your blood glucose level before, during and after exercise as you don’t want to faint mid-workout (due to hypoglycaemia) or risk damaging organs such as the kidneys, heart, eyes and nerves in the long run (due to hyperglycaemia).

Before exercise: If you’re on insulin or other blood glucose-lowering medications, check that your blood glucose level is within the safe range (usually 100mg/dL to 250mg/dL or 5.6mmol/L to 13.9mmol/L) 15 to 30 minutes pre-exercise, said Mary-ann Chiam, a senior principal dietitian with Allium Healthcare. You don’t have to take such precautions if you’re not taking medication, she said.

Hypoglycaemia generally occurs with treatments that involve insulin or other glucose-lowering medications. If your blood glucose level is low, see Scenario No. 2 on how to tackle it. Or it may be a matter of exploring other medications and adjusting the instructions.

“For individuals with Type 2 diabetes, there are some medications that do not cause hypoglycaemia,” said Prof Tai. Or “it may be a question of delaying some of your medication until after exercise when you are ready to eat. For Type 1 patients, they may need to adjust their insulin”. It is best to discuss with your doctor before making any changes.

Recheck your blood glucose level 15 minutes later and if it’s still too low, have another 15g of carbohydrates – and test again 15 minutes later, said Chermine. “Repeat as needed until your blood sugar reaches at least 70mg/dL (3.9mmol/L). If you haven’t finished your workout, continue once your blood sugar returns to a safe range.”

Another thing to take note is, make sure your shoes fit well as your feet are prone to nerve damage or blocked blood vessels, said Prof Tai. “If you have heart disease, you’ll need to pay attention to things like chest pain or increased breathlessness, which may indicate a worsening of your heart conditions.”

After exercise: Check your blood glucose level as soon as you finish exercising and again several times during the next few hours, said Chermine.

“Exercise draws on reserve sugar stored in your muscles and liver,” she said. “As your body rebuilds these stores, it takes sugar from your blood. The more strenuous your workout, the longer your blood glucose will be affected. A low blood glucose level is possible even four to eight hours after exercise.”

To prevent drops in your blood glucose level, snack on slower-acting carbohydrates such as a granola bar or trail mix. Or consume a small carb-containing snack such as a fruit, crackers, glucose tablets or drink half a cup of fruit juice, said Chermine.

Scenario 4: There are so many things to bring when I want to go to the gym

Do what Cheryl recommended: Prep a small diabetes pack that you can drop into your gym bag – and replenish the contents when they run low.

Here’s what you can include in the kit: A glucometer, a pack of biscuits, a pack of instant Milo, glucose tablets and sweets. “Ensure that there are sufficient glucose-testing strips, lancets and alcohol swabs for the glucometer,” she said. And if your gym already provides glucose tablets and gels, you have fewer things to pack.

These days, blood glucose tracking and insulin management can be better managed with technology, said Chermine, which helps to eliminate some of the paraphernalia. For instance, an insulin pump not only dispenses the exact amount of insulin you need throughout the day, it also eliminates the need to pack syringes or insulin pens. Have a chat with your doctor on your suitability for an insulin pump.

Scenario 6: I’m not sure if I can take protein and other muscle-building supplements

If your diabetes is not under control and you have kidney problems, protein shakes are off the table for you, said Mary-ann. Moreover, you’ll need to “adjust your protein intake accordingly as your kidneys are unable to excrete the waste products from protein digestion”, she said.

What about upping your protein intake with foods such as chicken breast and eggs if you manage to keep your blood glucose level nice and even? “It is more important to have a balanced meal with foods that have high fibre, low GI and moderate protein, rather than having purely protein-rich foods, which are often also high in fat,” said Mary-ann. If you’re not sure, get a dietitian to customise a diet that is appropriate for your diabetic and active needs, she said.

The key takeaway? Check with your doctor or dietitian before buying anything, advised Cheryl. “Certain sports supplements such as creatine may not be suitable for individuals with diabetic nephropathy or impaired kidney function.”

Even sports or energy bars and drinks that are marketed for the active crowd may contain high levels of sugar and fat, so always check the nutrition label, she said.

Here’s an example of an appropriate amount of carbs to have after an hour of aerobic exercise that typically burns about 455 calories, according to Mary-ann: 15g of quick-acting carbs from one glucose tablet or one tablespoon of honey in a cup of warm water. Then, follow through with 15g of long-acting carbs such as a slice of wholemeal bread with lettuce or tomatoes.

What about artificial sweeteners? Are they suitable for those with diabetes looking to lose weight? “The truth is that artificial sweeteners, when consumed, are processed differently by the body than regular sugar, which can interfere with the body’s learned taste,” said Mary-ann.

“This can cause confusion in the brain and result in signals that trigger the desire to eat more, especially sweet foods. They can also alter gut bacteria, which is important for weight management. Therefore, for people with diabetes looking to manage their weight or sugar intake, it is important to note that artificial sweeteners may not be a good substitute,” said Mary-ann.

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