Nov 10, 2008

Get Moving! New Physical Activity Guidelines! (Part 4)

Amy Campbell

This week, we'll wrap up our series on exercise. I hope that at least some of this information has been useful and relevant for you, with the belief that physical activity is one of the cornerstones of diabetes self-management.

Exercise and Hypoglycemia
One potential concern or barrier that some people have when they commit to an exercise program is hypoglycemia (low blood glucose). Hypoglycemia is defined as a blood glucose level under 70 mg/dl. Typical symptoms include shakiness, sweatiness, anxiety, hunger, and irritability.

Not everyone with diabetes is at risk for hypoglycemia, however. Those who are include people who take insulin and people who take certain types of diabetes pills, such as the following.

Sulfonylureas:

• Chlorpropamide (brand name Diabinese)
• Glimepiride (Amaryl)
• Glipizide (Glucotrol)
• Glyburide (DiaBeta, Glynase, Micronase)
• Glyburide and metformin (Glucovance)
• Tolazamide (Tolinase)
• Tolbutamide (Orinase)

Meglitinides:

• Nateglinide (Starlix)
• Repaglinide (Prandin)

You have practically no risk of hypoglycemia if you take metformin alone, however.

Remember that physical activity lowers blood glucose by enhancing the action of insulin. In other words, when you're exercising, insulin helps your muscles and cells use glucose for fuel, thereby lowering the amount of glucose in your blood.

You can see why exercise is so beneficial for blood glucose control. However, if your insulin or diabetes pills are "peaking," or working at their hardest, there's a very real chance that your blood glucose will drop too low, either during or after exercise. In fact, hypoglycemia may occur up to 24 hours after you've stopped exercising (called the "lag effect"); this happens because your muscles draw glucose from your blood to replenish their glycogen (glucose) stores.

To make sure you stay safe while exercising, here are a few pointers for lowering your risk of hypoglycemia:

• Check your blood glucose before and after you exercise.
• If your blood glucose is less than 110 mg/dl before exercise, eat a snack containing 15 grams of carbohydrate, such as a piece of fruit or some crackers.
• If you take insulin and plan to exercise either before a meal or when your insulin is peaking, ask your diabetes care team how to reduce your insulin dose. If you take diabetes pills and frequently go low, ask your provider if you can reduce your medication dose.
• If you'd rather not cut back on your diabetes medication, plan to exercise after a meal, when your blood glucose is at its highest.
• Always carry a source of carbohydrate with you when exercising, such as glucose tabs or glucose gel, along with medical identification.
• Avoid drinking alcohol right after you've exercised.

Ideally, your blood glucose should be above 110 mg/dl after exercising. If it's below 110, you'll need to eat another 15 grams of carb.

Easy Ways To Be Active
Now you're armed with all sorts of information: why you should exercise, what and how much to do, how to start safely...still not quite ready? That's okay. Remember, it's fine to ease into it. Here are some suggestions that might get you started and motivated enough to take it to the next level.

• Get off the bus or train a stop early and walk the rest of the way.
• Suggest a "walking meeting" at work instead of sitting down.
• Give the cleaning person a week off and do your own housecleaning.
• Rather than send an e-mail to the person three doors down from you at work, get up and walk to his or her office.
• Skip the elevator and escalator and head for the stairs.
• Speaking of stairs, try climbing a few flights each day. Kick it up a notch by climbing two steps at a time.
• Stand up when you're talking on the phone. Do some leg squats while you're at it.
• March in place or use some hand weights during television commercials.
• Sign up for a class—yoga, spinning, dancing, fencing...whatever you've always wanted to try.

You can probably think of some other ways to be active, too.

If you'd like to check out the 2008 Physical Activity Guidelines for Americans, here's the link: www.health.gov/PAGuidelines/pdf/paguide.pdf.

I'll end with a quote from Dr. Elliott P. Joslin, 1924:

"It is better to discuss how far you have walked than how little you have eaten."

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