Preventing type 2 diabetes (Part 2)
Risk factors for diabetes
- Older than 45
- Overweight
- Close family member with diabetes
- Gestational diabetes
- Gave birth to 9 lbs.-plus baby
- African-American, Hispanic or
- Latino, Asian-American or
- Pacific Islander, or American-Indian
- High blood pressure
- High cholesterol or other abnormal
- blood fats
- Inactive
- Abnormal blood glucose test
Source: National Diabetes Education Program
What do I tell my client…
The scenario
An older woman just diagnosed with type 2 diabetes is preparing to start an exercise program. She wants to know how exercise will help her, plus exercise dos and don’ts.
The facts
An eight-week circuit training program improved “functional capacity, lean body mass, strength and glycemic control in subjects with type 2 diabetes.” Source: Diabetes Research and Clinical Practice 2002;56:115–123
A review of research states that progressive resistance training (PRT) “improves insulin sensitivity and glycemic control; increases muscle mass, strength, and endurance; and has positive effects on bone density, osteoarthritic symptoms, mobility impairment, self-efficacy, hypertension, and lipid profiles.” Source: Diabetes Care 2003;26:1580–1588
A study of more than 50,000 men ages 40–75 years shows that physical activity reduces the risk for heart attack and death in men with type 2 diabetes. Diabetic men in the third highest of four categories of total physical activity reduced their risk of heart disease by 36% and death by 43% compared to those in the lowest category. Source: Circulation 2003;107:2435–2439, 2392–2394
The solution
Ensure your client has medical clearance to exercise. Check whether resistance training is specifically approved and note any cautions. If your client relies on insulin, suggest she consult her healthcare provider about coordinating her exercise and insulin.
Urge your client to monitor her blood glucose levels to find out how exercise affects her blood sugar. To prevent hypoglycemia, your client should check her blood glucose before and after exercise, plus monitor levels for at least 12 hours after exercise. Checking blood glucose during workouts is usually advised for people who take insulin or oral diabetes medicines, as well as for individuals doing long workouts or just starting an activity. Ask your client whether she takes beta-blockers, which can mask symptoms of low blood sugar. Advise her to keep a sugar source handy in case she becomes hypoglycemic.
If your client has autonomic neuropathy, recommend low-level daily activities that cause mild changes in heart rate and blood pressure. With nerve damage, she should avoid exercising in hot environments. Cold environments are also problematic if your client has peripheral vascular disease (loss of circulation). If your client has poor circulation, advise her to avoid cross-legged stretches and to select comfortable shoes that fit well. Emphasize attention to footwear and foot care, and caution your client to visit a healthcare provider at the earliest sign of a problem.
If your client has nerve damage, she may have weak muscles and poor reflexes in her feet. Her balance and gait may be affected. Suggest non-weight bearing activities, or consider alternating weight bearing with non-weight bearing exercise.
Recommend light weight training (RPE of 10–11) if your client has normal blood pressure, unless contraindicated. If your client has eye or kidney disease, caution her against exercise that raises her systolic blood pressure to 180–200 mmHg, i.e. arms frequently overhead. If your client has cardiovascular complications, tell her to avoid arms overhead exercise. Also, suggest she check her blood pressure and pulse before and after exercise.
If your client’s fasting blood glucose ever exceeds 300 mg/dl, advise her not to exercise until her blood sugar is under control or she visits her healthcare provider.
References
- Albright, A.; Franz, M.; et al. 2000. “ACSM Position Stand: Exercise and Type 2 Diabetes.” Medicine & Science in Sports & Exercise 2000;32:1345–60
- American Diabetes Association. “Healthy Living: Exercise: Getting Started: Safety Tips.” www.diabetes.org/main/health/exercise/safety/25ways.jsp, accessed July 8, 2003
- Best-Martini, E. and Botenhagen DiGenova, K.A. 2003. Exercise for Frail Elders. Champaign IL: Human Kinetics
This article is provided courtesy of the International Council on Active Aging www.icaa.cc