Diabetes and Physical activity

The aim of increased physical activity is to perform movements that increases Energy usage, Physical activity in terms of Exercises is a structured method to deliver physical fitness.

The benefits of Exercises for a Diabetic are:

1. Improves blood glucose control
2. Reduce cardio-vascular risks
3. Contribute to weight loss
4. Improve wellbeing

Structured exercise intervention over 8 weeks has been shown to lower A1c by 0.66%, in Type 2 Diabetics even without a change in BM

FREQUENCY & TYPES OF PHYSICAL ACTIVITY

• Regular Aerobic and Resistance training of around 30 minutes /day for most of the week is recommended.
• Daily activity is preferred, otherwise not more than 2 days of gap in between to decrease the insulin resistance.
• Overtime progress to increase the intensity , strength and duration, targeting150 minutes /week of moderate intensity
• Running @ 10 km/hour for 25 minutes can benefit sufficiently from 75 minutes /week
• Also 2-3 sessions of resistance training /week on nonconsecutive days.

Resistance training of any intensity is useful for

1. Improving strength
2. Improving balance
3. Improving ability to engage in daily activities

• To reduce the time in sedentary state by briefly walking ,standing, or performing activities while watching T.V. and Computers.
• Participating in leisure like activities and avoiding prolonged sedentary period reduces risk of Diabetes and aids in Glycemic control
• Yoga and Tai Chi have significant effect on A1c , flexibility, and balance.

PRE EXERCISE EVALUATION

• Careful history of past events. assessment of Cardio Vascular functions is a must.
• Beware of the Atypical presentation of Coronary Artery disease  signs like reduced  exercise tolerance recently.
•  High Risk patients should start with short periods of low intensity Exercises and slowly increasing intensity and duration as tolerated. 
• Contraindications to be assessed like uncontrolled Hypertension, untreated Proliferative Retinopathy, Autonomic neuropathy, Peripheral neuropathy, ,Foot Ulcers and Charcot Foot.
• Those with high risk and complications should be evaluated before.

HYPOGLYCAEMIA

Hypoglycaemia is precipitated when exercising while one is, on insulin or Insulin secretagogues like Glimeperide (Amaryl, Glimisave ,Gemer, GP) or Diamicron, Cyblex 

It happens in an scenario :

• If carbohydrate intake has not been adjusted or medication is not adjusted for the exercise bout and the post bout impact on the blood glucose.
• If pre-exercise blood glucose is <90 mg ingest Carbohydrates
• Hypoglycaemia may continue for certain hours after the exercises as performing exercises improves the Insulin sensitivity
• Usually Hypoglycaemia don’t occur when a patient is in other oral drugs.
• Insulin dosage is to be adjusted if it is pre-exercise, and depends on

1. Intensity of exercise
2. Time of exercise
3. Duration of exercise

TIMING OF EXERCISES

• The best time of exercises is in the morning time and in a Fasting state , avoiding even the Bed Tea and biscuits
• The significant advantage of walking in a fasting state is that when a person walks or exercises in a fasting state, the Fat depot in the body is used as a source of Energy and Caloric expenditure, thereby mobilizing the stored Fat.
• Another big advantage of this initiation of Fat mobilization is that this process continues further on for next 6-8 hours , despite the person resting and not exercising.
• If one exercises in a fed state, the source of energy is Carbohydrate ie, Sugar and it’s usage as a source stops as soon as one stops the exercises, so the person reduces his sugar definitely, but not weight.