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Diabetes and exercise: how to get started?

We all know exercise is good for us — and a key part of diabetes management — but why does it have to be so hard? MYKE BARTLETT looks at ways of getting active, even when you don’t want to.

Let’s get personal for a minute here. I spent most of my life thinking exercise was something that only happened to other people. There were strange people who enjoyed physical activity and, well, there were me and my friends. And, yet, back in the cold darkness of a Melbourne winter during the second 2020 lockdown, I took up running. It was awful. What helped was a staggered program that saw me run for 60 seconds, then three minutes, an impossible ten minutes and, finally, for a full half hour.

These days, I run five kilometres three times a week (weather permitting). I can’t say I enjoy it, but it turns out I like being fit. The only annoying thing is, now I know what it feels like to be fit, I have to keep going.

For people living with diabetes, the difference exercise can make to your blood glucose management and quality of life is immense. If you’ve been diagnosed with prediabetes, there is compelling research that suggests regular physical activity is as effective (if not more effective) at managing your blood glucose levels than medication.

Accredited exercise physiologist and credentialled diabetes educator Dr Marian Brennan PhD says the relationship between exercise and diabetes is complex, but well-established. “The way exercise manages diabetes and blood glucose levels is fascinating,” Marian says.

“When our muscles contract during activity, a special pathway is created allowing glucose to enter our muscle cells without the need for insulin, meaning glucose moves from the blood into the cells more quickly than normal. This effect can even last for a few hours after we exercise!”

Getting started with an exercise regime isn’t always easy. People with type 2 diabetes experience many of the same barriers to physical activity as the rest of the population — such as a lack of time or a lack of access. There is also some concern about pre-existing conditions and injuries and some may worry about how to balance insulin intake with increased levels of exercise. Marian says research shows that people with type 1 also report additional diabetes-specific barriers to getting active.

“The top three barriers mentioned by those living with type 1 diabetes were a fear of experiencing low blood glucose levels with exercise; a lack of time, motivation and energy due to the high management demand of type 1 diabetes; and limited health professional advice on how to manage blood glucose levels for exercise.”

Despite these concerns, the good news is that, whatever your type of diabetes, you generally won’t need medical clearance to start a graded or moderately intensive exercise program.

“As diabetes can increase the risk of cardiovascular conditions, if you have experienced any recent new chest pain, recent heart attack or stroke, or if your blood glucose levels have been over 15mmol/L regularly, it might be worth having a quick chat to the GP just to make sure you’re safe to get started,” Marian says.

For those experiencing diabetes-related conditions like some forms of retinopathy or foot ulcers, getting advice from your specialist and an accredited exercise physiologist is recommended. It is recommended that those using insulin to manage their diabetes monitor their blood glucose levels before, during and after activity to make sure they are within their target ranges. It may also be worth chatting to your diabetes healthcare team about adjustments to your insulin dose to avoid low glucose levels.

“People living with type 1 diabetes are at greater risk of experiencing low blood glucose levels with exercise exceeding 30 minutes,” Marian says. “But regular monitoring, insulin and carbohydrate adjustment can help reduce this risk.”

Age is also a factor — but older folk shouldn’t worry too much about counting the years when it comes to getting started.

“Age is very relative!” Marian says. “But I would focus on your current ability and general health rather than the number. One consideration, is that if you’re using insulin to manage your diabetes, your risk of experiencing low glucose levels increases as you get older. But there are ways to minimise this risk so that you can still enjoy your physical activity.”

So, age and diabetes needn’t get in the way of anyone getting fit. But what about if, like me, you really don’t like exercise?

“I would say, let go of what you might perceive to be exercise and find movement or activity that you enjoy,” Marian says.

“Physical activity can take many forms and while for some that might involve structured and possibly intense physical activity, you do not have to start or even end up there! Get creative and think of ways to move your body that are within your comfort zone. If you’re struggling and are not sure of what you can do, particularly if you feel you are limited because of injury, pain, or illness, speak to an accredited exercise physiologist who will be able to work with you to tailor activity that you can do and you enjoy.”


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