Regular exercise for individuals with type 1 and type 2 diabetes has a positive effect on the body’s ability to use insulin (insulin sensitivity) and transport glucose to the cells. Patients who require insulin may need to adjust their insulin dose or dietary intake. For this reason, the intensity, duration and glucose levels prior to exercise must be taken into consideration.

For people with the much more common type 2 diabetes, which is often associated with obesity, exercise, along with health eating, helps take weight off and keep it off. It also helps keep blood sugar levels in check by improving insulin sensitivity.

“I have seen people be able to get off of insulin and others who only had to take one oral medication for their diabetes as a result of making lifestyle changes,” Green says. “They listened to a dietitian, started an exercise routine and lost weight. They realized that it was not only good for them, but they felt better because their blood sugars were under control.”

The benefits of exercise Green teaches a class on the benefits of exercise as part of FirstHealth’s Diabetes Self-Management Program. If diabetes isn’t well controlled, it can cause a number of serious complications. It is a leading cause of heart disease, so it isn’t surprising that about half of the patients in FirstHealth’s Cardiac Rehabilitation Program have diabetes. “If heart patients also have diabetes, we usually structure their exercise programs a little differently,” says Betsy Young, an exercise physiologist who coordinates Cardiac Rehab in Rockingham and Pembroke. “For someone who has type 2 diabetes and is overweight, one of the main goals of exercise is to burn calories. But since they are overweight, we need to make sure the exercises they are doing aren’t putting too much stress on their joints and feet.”

Exercise physiologist Kathy Summers works with patient John Ferguson as part of the exercise regimen that helps control his diabetes.

Low-impact exercises such as swimming, pedaling a stationary bike, or using a rowing machine might be better than jogging or even walking on a treadmill.

“Swimming is good, because it’s easy on the joints, and you use a lot of muscles without a lot of stress,” Green says.

Walking or jogging in a pool can be good exercise, too, because the water provides resistance and makes the muscles work. For people who can’t walk very far or even stand for very long, there are arm and leg exercises that can be done while sitting in a chair.

Most people who have type 2 diabetes didn’t go to bed healthy one night and wake up the next morning with diabetes. Their blood sugar levels rose gradually. If someone’s blood sugars are higher than they should be but not high enough to be considered diabetes, they have a condition called pre-diabetes. These people are at high risk of developing diabetes if they don’t make some lifestyle changes.

“They may be able to control their blood sugars and prevent full-blown diabetes through a combination of diet and exercise,” Green says.

It is a good idea for anyone who isn’t used to getting much exercise to consult his or her doctor before starting an exercise program. That is especially important for people with diabetes.

“They need to go through a thorough medical screening to make sure they can exercise safely,” says Jean Barrett-Taylor, director of FirstHealth’s Diabetes Self-Management and Cardiac Rehab programs. “The main thing is to identify any complications from their diabetes so that those can be taken into consideration in prescribing any kind of exercise.”

Before starting to exercise, people with diabetes should have a blood pressure check and an EKG to make sure their heart is in good shape. An exercise stress test is recommended for people over 35 who have had diabetes for at least 10 years, even if they have no symptoms of heart disease.

According to Young, anyone who has both diabetes and heart disease probably should be in a medically supervised exercise program such as Cardiac Rehab. “We can look at their EKG when they exercise and monitor their blood pressure and any symptoms they have,” she says.

While most people with diabetes don’t need someone watching over them every time they exercise, Barrett-Taylor says, exercise physiologists can offer valuable guidance in starting or changing an exercise program.

“An exercise physiologist can prescribe the type of exercise and the level of intensity that best meets each person’s needs,” she says.

Lowered blood sugar levels
One reason that exercise is so good for people with diabetes is that it helps lower blood sugar levels. It is important, though, not to let blood sugars drop too low. A very low sugar level—a condition called hypoglycemia—can be more of an emergency than a very high sugar level. Symptoms of hypoglycemia differ from person to person but often include lightheadedness, hunger, blurred vision, feeling shaky, nervous or irritable, headache or a rapid heartbeat.

“If your blood sugar level is already low and then you exercise, it’s going to drop even lower,” Young says. “So it’s important to monitor your blood sugar before you exercise to see if you need to eat a snack to bring your blood sugar level up. You shouldn’t exercise right after taking insulin or when the effect of your oral diabetes medication is at its peak. With the medication and exercise both pulling the blood sugar down, you can have a big problem.”

Barrett-Taylor says that it’s also a good idea to check your blood sugar right after exercising and again an hour or so later.

“Blood sugars tend to drop for several hours after you finish exercising,” she says. “That’s part of the beauty of exercise.”