CHICAGO _ When Jay Smith fell off his jogging routine, he gained 25 pounds and
saw his average blood sugar level climb into dangerous territory.
So Smith, a 48-year-old Type 1 diabetic, did what many people do when they need
to get in shape: He began a diet and workout regimen. But while exercise
benefits everyone, diabetics in particular can see dramatic improvements in
After completing the 12-week Weight Achievement and Intensive Treatment (Why
WAIT) fitness program at the Boston-based Joslin Diabetes Center, Smith lost the
25 pounds and saw his hemoglobin A1C level, a measurement that reflects a
person's average blood sugar level over several months, drop from 8 percent to
5.8 percent (7 percent or less is a common treatment target for diabetics). He
also has been able to cut his insulin intake in half and reduce his cholesterol
and blood pressure medications.
"Diabetics should consider exercise as a prescription; it is cheap and extremely
effective," said Dr. Osama Hamdy, medical director of the Obesity Clinical
Program at Joslin, a research and clinical care center affiliated with Harvard
Medical School. Hamdy also co-wrote "The Diabetes Breakthrough," an upcoming
book about the Why WAIT program, slated for March publication.
The weight loss that exercise helps hasten is a major driver of health
improvements, particularly for Type 2 diabetics, who often struggle with obesity
and constitute about 90 percent of the country's 23.6 million diabetics. Hamdy's
research on the Why WAIT program found that when obese Type 2 diabetics lost 7
percent of their body weight, their insulin sensitivity improved by 57 percent,
equivalent to taking two medications. Eighty-two percent of the participants
were able to reduce their medication by 50 to 60 percent.
His results mirrored an earlier major study of prediabetics, who are at greater
risk of developing Type 2 diabetes because their blood glucose levels are higher
than normal. That study found that doing 30 minutes of physical activity five
days a week reduced the five-year risk of getting diabetes by 58 percent. That
was more effective than taking the common antidiabetic drug metformin, which
reduced diabetes incidence by 31 percent, according to the study, published in
2002 in the New England Journal of Medicine. The Department of Health and Human
Services estimates that a quarter of U.S. adults 20 years or older, about 57
million people, had prediabetes in 2007.
Weight loss isn't the only way exercise benefits diabetics. Exercise helps drive
glucose out of the bloodstream and into cells, where it's used for fuel, making
diabetics less dependent on insulin to process their meals, said Dr. John
Anderson, president of medicine and science at the American Diabetes
Association. Strength training, even more than cardiovascular exercise, lowers
blood sugar levels for a longer duration, he said.
Strength training also helps build muscle mass, which is particularly important
for diabetics, Hamdy said. Everyone loses muscle mass as they age, but for
reasons not entirely clear, diabetics lose muscle faster, perhaps because of
metabolic abnormalities, he said. The quadricep muscles in the thighs are
Strength training is a must for diabetics who are dieting, Hamdy said. Dieting
accelerates the loss of muscle mass because people consume less protein, which
in turn decreases basal metabolic rate and makes it harder to lose weight or
sustain weight loss. When people lose weight just from dieting, 27 percent of
weight loss is from muscle mass, Hamdy said. If you add more protein and
strength training, muscle mass loss drops to 10 percent of weight loss, helping
to maintain the basal metabolic rate.
Hamdy said 300 minutes of activity per week is ideal for diabetics to obtain and
maintain good weight loss, incorporating a combination of aerobic exercises,
flexibility and, most important, strength training. Beginners can start with 20
to 30 minutes three times a week and build up slowly.
"It doesn't have to be running three miles and then going to the gym and
lifting," said Smith, who has been exercising five days a week since his program
ended. "It can be taking the dog for a walk and then working out with stretch
Because exercise lowers blood sugar levels, there is the risk of hypoglycemia.
Diabetics must plan accordingly and learn to recognize the symptoms, which vary
but often include sweating, nervousness, jitteriness, hunger and
lightheadedness, Anderson said.
Type 1 diabetics, who produce no or very little insulin, and some Type 2
diabetics who take insulin should be vigilant about monitoring their blood sugar
levels before and during workouts so that they know how much insulin they need,
Anderson said. He also advises they carry a carbohydrate source, like fruit
juice or glucose tablets, during workouts in case their blood sugar dips too
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Blair Ryan, 27, who was diagnosed with Type 1 diabetes when she was a freshman
in high school, last year completed an Ironman triathlon (2.4 miles of swimming,
112 miles of cycling and a 26.2-mile run) in Tempe, Ariz.
Ryan, who is the creative director at Insulindependence, a San Diego-based
nonprofit that promotes exercise and recreation for people living with diabetes,
said the most challenging part of being a diabetic athlete is figuring out her
insulin strategy so that she doesn't take too much before a workout, when the
exercise brings her blood sugar down, or too little before a race, when
adrenaline pushes her blood sugar higher.
A former collegiate runner, Ryan said she wore a continuous glucose monitor
during the Ironman and, to back up that data, pricked her finger at each of the
transition points to check her blood sugar on a glucometer. She worried that the
units of insulin she took before jumping in the pool at the starting line were
bringing her blood sugar levels too low, so she forced herself to eat carbs
during the race, which she believes ultimately benefited her performance,
because she had the necessary calories.
Ryan finished in 11 hours and 40 minutes, beating her 12-hour goal.
"I had a great day, and although I stepped on the starting line undertrained, I
learned that a lifetime of endurance athletics, having a solid insulin and
nutrition strategy, and support from friends and family goes a long way," she
(END OPTIONAL TRIM)
(EDITORS: STORY CAN END HERE)
PICKING THE RIGHT EXERCISE
Diabetics with complications from their disease must take care to avoid activity
that might aggravate their condition, Hamdy said.
For example, people with neuropathy, who have numbness in their feet, should
avoid the treadmill and opt instead for swimming or the stationary bike, he
said. People with eye complications should steer clear of strength exercises
because it could increase bleeding in the eye. People with high blood pressure,
which goes up during strength training, should have their blood pressure under
control before starting a routine. People with cardiovascular disease should do
a stress test.
Hamdy recommends seeing an exercise physiologist to determine the best course of
action. He also recommends patients test their blood sugar before and after
exercise to see how much it drops, so they can plan their carbohydrate
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